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Updated: Apr 27, 2026
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Extradural granulation complicated by chronic suppurative otitis media with cholesteatoma
Chul Ho Jang1, Yong Ho Choi2, Eun Sun Jeon2
1Department of Otolaryngology, Chonnam National University Medical School, Gwawngju, Republic of Korea chulsavio@hanmail.net.
Background:
Extrdural granulation or abscess is a possible complication of chronic suppurative otitis media (CSOM) with cholesteatoma. However, due to development of newer antibiotics and advances in bacteriology and imaging techniques, the incidence of extradural granulation or abscess has significantly decreased. The present study analyzed the clinical presentation, imaging findings, and surgical treatment of eight patients with CSOM with cholesteatoma extending to the cranial fossa.
Patients And Methods:
From 2000 to 2012, 1,010 patients were surgically treated for CSOM with cholesteatoma. Patients with extension to the cranial fossa were studied. Clinical presentation, imaging studies, operative findings, surgical treatment, and postoperative results were evaluated.
Results:
Twenty cases (1.9%) in a series of 1,010 patients with CSOM with cholesteatoma had bony destruction of the cranial fossa in the temporal bone computed tomography (cr). Of the 20 cases, eight (0.79%) were identified as extradural granulation by magnetic resonance imaging. One patient exhibited nodular enhancement, but it disappeared on preoperative antibiotic treatment. Surgical access for removal of cholesteatoma with extradural granulation was accomplished through canal wall-down tympanomastoidectomy.
Conclusion:
CSOM with cholesteatoma can extend to either the middle or posterior cranial fossa. While CT is sufficient to reveal bony destruction of the cranial fossa, magnetic resonance imaging is required to differentiate and define intracranial extension of CSOM with cholesteatoma.
Insights
Chronic suppurative otitis media with cholesteatoma can extend to the cranial fossa. Magnetic resonance imaging is crucial for diagnosing intracranial extension, differentiating it from granulation tissue.
Area of Science:
- Otolaryngology
- Neurosurgery
- Radiology
Background:
- Extradural granulation or abscess is a known complication of chronic suppurative otitis media (CSOM) with cholesteatoma.
- Advances in antibiotics and imaging have reduced incidence, but complications still occur.
- This study focuses on CSOM with cholesteatoma extending to the cranial fossa.
Purpose of the Study:
- To analyze the clinical presentation, imaging findings, and surgical treatment of patients with CSOM and cholesteatoma extending to the cranial fossa.
- To evaluate the diagnostic utility of CT and MRI in these cases.
Main Methods:
- A retrospective review of 1,010 patients surgically treated for CSOM with cholesteatoma between 2000 and 2012.
- Analysis of clinical data, imaging studies (CT and MRI), operative findings, and surgical outcomes for patients with cranial fossa extension.
Main Results:
- Twenty cases (1.9%) showed bony destruction of the cranial fossa on CT.
- Eight of these cases (0.79%) were identified as extradural granulation via MRI.
- Canal wall-down tympanomastoidectomy was used for surgical removal.
Conclusions:
- CSOM with cholesteatoma can extend into the middle or posterior cranial fossae.
- CT effectively detects bony destruction, but MRI is essential for diagnosing intracranial extension.
- MRI aids in differentiating granulation from abscess and defining the extent of disease.
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Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...