Editing Cholesteatoma (section)

==Signs and symptoms==

Other more common conditions (e.g. [[otitis externa]]) may also present with these symptoms, but cholesteatoma is much more serious and should not be overlooked. If a patient presents to a doctor with ear discharge and hearing loss, the doctor should consider cholesteatoma until the disease is definitely excluded.<ref name=":3" /> Other less common symptoms (all less than 15%) of cholesteatoma may include pain, [[balance disorder|balance disruption]], [[tinnitus]], [[ear ache|earache]], [[headache]]s and bleeding from the ear.<ref name=":1" /> There can also be [[facial nerve]] weakness. Balance symptoms in the presence of a cholesteatoma raise the possibility that the cholesteatoma is eroding the balance organs in the [[inner ear]].<ref name=":2" />

Doctors' initial inspections may only reveal an ear canal full of discharge. Until the doctor has cleaned the ear and inspected the entire [[tympanic membrane]], cholesteatoma cannot be diagnosed.<ref name=":1" /> Once the debris is cleared, cholesteatoma can give rise to a number of appearances. If there is significant inflammation, the tympanic membrane may be partially obscured by an aural [[Polyp (medicine)|polyp]]. If there is less inflammation, the cholesteatoma may present the appearance of 'semolina' discharging from a defect in the tympanic membrane. The posterior and superior parts of the tympanic membrane are most commonly affected. If the cholesteatoma has been dry, the cholesteatoma may present the appearance of '[[wax]] over the attic'. The attic is just above the [[eardrum]].

If untreated, a cholesteatoma can eat or cause erosion of the three small bones located in the middle ear (the ''[[malleus]]'', ''[[incus]]'' and ''[[stapes]]'', collectively called [[ossicles]]).<ref>{{Cite journal |last1=Hilal |first1=Fathi |last2=Liaw |first2=Jeffrey |last3=Cousins |first3=Joseph P. |last4=Rivera |first4=Arnaldo L. |last5=Nada |first5=Ayman |date=2023-04-01 |title=Autoincudotomy as an uncommon etiology of conductive hearing loss: Case report and review of literature |url= |journal=Radiology Case Reports |language=en |volume=18 |issue=4 |pages=1461–1465 |doi=10.1016/j.radcr.2022.10.097 |issn=1930-0433 |pmc=9925837 |pmid=36798057}}</ref> This can result in nerve deterioration, imbalance, [[Vertigo (medical)|vertigo]], and [[deafness]] early in the disease.<ref>{{Cite journal |last1=Falcioni |first1=M. |last2=Taibah |first2=A. |last3=Rohit |date=2006-03-08 |title=Pulsatile tinnitus as a rare presenting symptom of residual cholesteatoma |url=https://www.cambridge.org/core/product/identifier/S0022215104000428/type/journal_article |journal=The Journal of Laryngology & Otology |language=en |volume=118 |issue=2 |pages=165–166 |doi=10.1258/002221504772784694 |pmid=14979961 |issn=0022-2151}}</ref> It can also affect and erode, through the [[enzyme]]s it produces, the thin bone structure that isolates the top of the ear from the brain, as well as lay the covering of the brain open to infection with serious complications (rarely even death due to [[brain abscess]] and [[sepsis]]).

Both the acquired as well as the congenital types of the disease can affect the [[facial nerve]] that extends from the brain to the face and passes through the inner and middle ear and leaves at the anterior tip of the [[mastoid portion of the temporal bone|mastoid bone]], and then rises to the front of the ear and extends into the upper and lower face.