Neurologische presentaties van een cholesteatoom

A cholesteatoma is a space-occupying process in the middle ear, which results from accumulation of epithelium and keratin, usually from a weaker part of the eardrum (Shrapnell’s membrane). A cholesteatoma has locally destructive properties. Clinical presentation varies depending on stage and location. Typically, symptoms are otological, like otorrhea and hearing loss. However, local destruction not only leads to erosion of the auditory ossicles, but can also lead to erosion of the labyrinth, facial canal and tegmen tympani. This can lead to neurological symptoms such as vertigo, facial paresis or presentation of meningitis or cerebral abscess. In this article, 3 cases are discussed in which patients with a cholesteatoma present with neurological symptoms. Early recognition by neurologists and neurosurgeons is important to prevent permanent damage. Otological history, otoscopy and CT of the petrous temporal
bone are usually sufficient for diagnosis of cholesteatoma. MRI can confirm a cholesteatoma (MRI diffusion-weighted imaging) and show intracranial
complications. Intracerebral complications of a cholesteatoma require a multidisciplinary approach.