Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Ear Cysts (Cholesteatoma and Preauricular Cyst)

—

In one line

·An abnormal skin growth or fluid pocket in or near the ear that can erode nearby bone.

—

Normal physiology

·The ear is built in three parts: the outer ear (the part you see and the ear canal), the middle ear (an air-filled space behind the eardrum that holds three tiny bones—hammer, anvil, and stirrup—which pass sound vibrations along), and the inner ear (a fluid-filled snail-shell called the cochlea that turns vibrations into nerve signals, plus balance loops that tell your brain which way is up). The eardrum is a thin sheet of tissue that seals the ear canal from the middle ear; it vibrates when sound waves hit it. The middle ear is normally lined with a thin, moist layer of cells that make a tiny bit of mucus and are connected to the back of the throat by a tube (the Eustachian tube) so air pressure stays equal on both sides of the eardrum. The skin of the outer ear canal and the outer layer of the eardrum naturally shed dead cells, which fall out of the ear on their own. Just in front of the ear, the skin of the face forms during development as separate pieces that zip together; when that zip is complete, there are no tunnels or pockets left behind.

—

What goes wrong

·In a cholesteatoma, skin ends up growing in the middle ear—a place where skin should never be. That skin behaves just like normal skin: it grows, sheds, and piles up dead cells. But because it's trapped behind the eardrum or in the mastoid bone (the honeycomb bone behind the ear), the dead skin can't fall out. The buildup gets infected by bacteria, and both the bacteria and the body's own enzymes (chemicals released to fight infection) start dissolving the bone around them—first the tiny hearing bones, then the bone protecting the inner ear, the facial nerve (which moves your face), and even the covering of the brain. In a preauricular cyst, a tiny tunnel of skin that should have disappeared before birth stayed behind in front of the ear. That tunnel sheds skin cells into itself, and if bacteria get in (often from the skin surface), the pocket fills with pus and swells into a painful, red lump.

—

Hallmark signs

·Foul-smelling ear drainage
·Hearing loss in one ear
·Feeling of fullness or pressure in the ear
·Ear pain or aching
·Small pit or opening in front of the ear (preauricular cyst)
·Swelling or lump in front of or behind the ear
·Dizziness or problems with balance
·Weakness of the face on one side

—

Red flags · escalate now

·Facial droop or weakness on one side of the face
·Severe headache, stiff neck, or confusion (signs that infection may have spread to the brain or its coverings)
·Sudden severe dizziness or spinning sensation that doesn't go away
·High fever with ear pain or drainage (suggests infection is spreading beyond the ear)

—

Workup

·Otoscopy (looking into the ear canal with a lighted scope) and pneumatic otoscopy (gently puffing air to see if the eardrum moves)
·High-resolution CT scan of the temporal bones (the skull bones that hold the ear structures), with thin cuts (1 mm slices) and no contrast dye
·Audiometry (formal hearing test in a soundproof booth with headphones, measuring air conduction and bone conduction at different pitches)
·MRI of the temporal bones with diffusion-weighted imaging (DWI) sequences
·Culture of ear drainage (swab the fluid coming out of the ear and grow bacteria in the lab)
·Ultrasound of the preauricular area (using sound waves to make a picture of the lump near the ear)

—

Treatment

·Surgical removal of cholesteatoma (mastoidectomy and tympanoplasty) — the surgeon opens the mastoid bone, removes all the abnormal skin and infected tissue, and rebuilds the eardrum and hearing bones if they are damaged
·Topical antibiotic ear drops (ciprofloxacin or ofloxacin drops) for infected cholesteatoma with drainage
·Oral antibiotics (amoxicillin-clavulanate, cephalexin, or clindamycin) for infected preauricular cyst with redness and swelling
·Incision and drainage of an abscess (if the preauricular cyst has formed a large pocket of pus) — the doctor cuts open the swollen area, drains the pus, and packs the wound
·Surgical excision of the preauricular sinus tract (the surgeon removes the entire tube of skin from the surface down to where it ends, often near the cartilage of the ear) — done electively when there is no active infection
·Hearing aids or bone-anchored hearing devices (if the cholesteatoma has caused permanent hearing loss that surgery cannot restore)

—

NCLEX trap

·Drainage from a hole in the eardrum (perforation) plus pain, hearing loss, or a foul smell can signal cholesteatoma—a ball of skin cells growing inside the middle ear like a tumor. It can destroy bone. You must send the patient to an ear-nose-throat (ENT) specialist for a closer look with a microscope and possibly a CT scan of the temporal bone (the thick bone behind the ear).
·A pit or lump right in front of the ear opening, there since birth, is most often a preauricular cyst or sinus—a leftover tube from when the ear was forming before birth. If it gets red, warm, or drains pus, it's infected and needs antibiotics, warm soaks, and sometimes drainage. Even if it looks quiet now, you refer to ENT for possible removal later, because these pits tend to get infected over and over.
·Most ear cysts are not emergencies. A preauricular cyst that is infected gets antibiotics first; surgery (excision) is done weeks later after the infection clears, to prevent scarring and incomplete removal. Cholesteatoma is serious because it slowly destroys bone and can cause brain infection (meningitis) or facial paralysis, but the ENT schedules surgery when it's safe—rarely the same day—unless there's already a complication like severe infection spreading into the skull bone (mastoiditis) or an abscess behind the ear.
·Cholesteatoma is a skin growth, not an infection, so antibiotics can calm down any infected drainage temporarily but will never make the cholesteatoma disappear. The only cure is surgery to remove the ball of skin cells and repair any damage it caused. Without surgery, it keeps growing and can erode the tiny hearing bones (ossicles), the balance organ (labyrinth), the facial nerve, or even the bone covering the brain, leading to permanent hearing loss, dizziness, facial droop, or life-threatening brain infection.
·Foul-smelling, often whitish or cheesy discharge—especially if it keeps coming back and there's a hole in the eardrum that won't heal—raises the red flag for cholesteatoma. Children with repeated middle-ear infections (otitis media) or tubes in the ears are at higher risk. You do not watch and wait; you refer to ENT urgently (within days to weeks) because untreated cholesteatoma can cause permanent hearing loss and serious complications. Normal ear-infection discharge is usually yellow or clear, not foul-smelling.

—

Install Maldek by Hill as an app — studies work even offline