This passage describes ossicular destruction in atticoantral disease and the tissue reaction and appearance of cholesterol granuloma.
Ossicular destruction and hearing
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Ossicular necrosis is common in atticoantral disease. Destruction may be limited to the long process of the incus or extend to the stapes superstructure, handle of the malleus or entire ossicular chain.
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Hearing loss is described as greater than in tubotympanic disease. Occasionally, cholesteatoma bridges the gap left by destroyed ossicles, making hearing loss unapparent; this is termed a cholesteatoma hearer.
Cholesterol granuloma
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Cholesterol granuloma consists of granulation tissue with foreign body giant cells surrounding cholesterol crystals.
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It is a reaction to long-standing retention of secretions or haemorrhage and may occur with or without cholesteatoma.
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When it occupies the mesotympanum behind an intact tympanic membrane, the membrane appears blue.