Dawaa Reference

Clinical reference

Cholesteatoma

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class HD05.00 - condition scope only, no dose · Middle Ear Cholesteatoma - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK448108/ · No dose - referral pathway, no medicine given in primary care

Verified against1 document
  • No dose - referral pathway, no medicine given in primary care

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • Painless ear drainage, either ongoing or coming and going, is the textbook presentation
  • The condition affects only one ear in about 85% of cases
  • Hearing loss can occur, but how bad it is can be hard to judge because the small ear bones may be disrupted [hearing loss]
  • Dizziness is a worrying complaint that can mean the ossicles have eroded into the inner ear, forming a fistula [dizziness · fistula]
  • Facial weakness shows up in roughly 1 to 3.4% of patients [facial weakness]
  • History-taking should cover whether ear symptoms are one- or two-sided, and any past ear infections treated with antibiotics

Signs — what you find (5)

  • On otoscopy the classic finding is a white pearly or yellow mass sitting in a retracted pocket, usually toward the back and top of the eardrum
  • Foul-smelling white or yellow drainage in the canal can hide the underlying lesion on exam
  • Suctioning discharge under the microscope can show an eardrum hole, whether the ossicles are intact, and any mastoid bone erosion
  • Granular polyps seen on exam may be attached to the ossicles or the facial nerve and need careful handling [polyp]
  • Facial movement is checked and recorded as a standard part of the exam

Tests (8)

  • Diagnosis rests mainly on history, exam, hearing tests, and imaging - lab work and biopsy are usually not needed
  • Hearing testing before and after surgery covers air and bone conduction, speech thresholds and discrimination, tympanometry, and reflexes
  • CT scanning before surgery may be skipped unless the diagnosis or extent is unclear, the anatomy is uncertain, or a birth anomaly such as atresia is suspected
  • A thin-cut, non-contrast temporal bone CT is the preferred scan for finding bone defects, though it can struggle to tell apart granulation tissue, keratin debris, and fluid
  • On T2-weighted and high b-value diffusion MRI sequences, the lesion shows up bright
  • On plain unenhanced T1 MRI, the lesion looks the same brightness as surrounding tissue
  • MRI is considered a must when there is dural involvement, an abscess, brain herniation into the mastoid, inner-ear or facial nerve inflammation, sinus clot, or meningitis
  • Pairing temporal bone CT with diffusion MRI can sharpen both sensitivity and specificity of the workup

If not this — what else fits (2)

  • Other ear infections to weigh include acute or chronic suppurative otitis media, malignant otitis externa, fluid behind the drum, and tympanosclerosis
  • Structural and granulomatous mimics include a middle ear bone growth, a perforated eardrum, cholesterol granuloma, granulomatosis with polyangiitis, histiocytosis, tuberculosis-type infection, or rare temporal bone cancer

SourceStatPearls "Middle Ear Cholesteatoma" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

An abnormal skin growth in the middle ear that erodes bone and needs surgical removal; the GP can treat a secondarily infected, discharging ear while arranging ENT referral, but cannot treat the underlying disease. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

An abnormal skin growth in the middle ear that erodes bone and needs surgical removal; the GP can treat a secondarily infected, discharging ear while arranging ENT referral, but cannot treat the underlying disease.

Cautions
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - Facial weakness, worsening vertigo or hearing loss, or signs of intracranial spread such as severe headache, fever or neck stiffness: refer urgently.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.