Discharge, hearing and bleeding in an ear with cholesteatoma
THE CONTEXT
Symptoms include scanty foul-smelling discharge, variable hearing impairment and bleeding during ear cleaning.
Discharge and obstruction
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Discharge is usually scanty and always foul-smelling due to bone destruction. It may be so scanty that the patient is unaware of it.
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Complete cessation of discharge from a recently active ear is concerning. Crusted discharge, inflammatory mucosa or a polyp may seal the perforation and obstruct drainage.
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When drainage is obstructed, pus may spread internally and cause complications.
Hearing and bleeding
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Hearing can remain normal if the ossicular chain is intact or if cholesteatoma bridges the gap left by destroyed ossicles. The latter situation is termed a cholesteatoma hearer.
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Hearing loss is mostly conductive, but a sensorineural component may be added.
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Granulations or a polyp may bleed during ear cleaning.