• Pathophysiology: chronic suppurative otitis media from a cholesteatoma erodes the bone of the labyrinth (most commonly at the arch of the horizontal canal)
• SSx: may be asymptomatic with progression of the cholesteatoma, dizziness, hearing loss (SNHL)
• Dx: CT may reveal bony erosion of the labyrinth, Fistula Test (nystagmus induced with pneumatoscopy, high false negative rate)
• Rx: surgical exploration via a mastoidectomy with exteriorization of the cholesteatoma (matrix should be left intact over the lateral SSC), graft site (fascia) if fistula is exposed, parenteral antibiotics if infected
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