A 30-year-old woman presents with long-standing ear discharge and a perforation in the pars tensa. Audiometry shows a 40 dB air-bone gap with a type B tympanogram. Intraoperatively, a pearly white mass is seen in the middle ear. What is the MOST likely diagnosis?

• A Secondary acquired cholesteatoma via marginal perforation ✓
• B Congenital cholesteatoma
• C Acquired cholesteatoma secondary to retraction pocket
• D Tympanosclerosis with a calcified plaque

Explanation

Secondary acquired cholesteatoma arises from migration of squamous epithelium through a marginal or posterosuperior pars tensa perforation, or via retraction pockets in the pars flaccida. In this case, the long-standing pars tensa perforation with intraoperative pearly white mass strongly suggests secondary acquired cholesteatoma. Congenital cholesteatoma is seen behind an intact tympanic membrane in children. Tympanosclerosis appears as white chalky patches, not a mass.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.