Petrous Bone Cholesteatoma: The Tip of the Iceberg

These are epidermoid cyst of the petrous temporal bone. They can occur anywhere in the middle ear, mastoid, petrous apex or CPA. They constitute 4 to 24% of all petrous bone pathologies. There is a male predominance (2–3:1).

They are usually silent for a variable length of time and can present at any age. The usual presentation is a complication. They are mainly diagnosed radiologically and the surgeons must have a very high index of suspicion when faced with a patient presenting with unexplained otological/neurotological signs and symptoms.

This presentation includes our institution’s experience of 52 petrous bone cholesteatomas and highlights the diagnostic and therapeutic challenges this pathology represents. All cases were surgically treated and the approach differed according to the anatomical location and hearing status of the patient.

There were no mortalities in the series and no additional neurological deficits. In most cases an additional conductive hearing loss was incurred in patients with residual hearing especially with subtotal petrosectomy.