Rosh Pediatrics Practice Exam

What is a key finding in a child with a cholesteatoma?

1. Absence of ear drainage

2. Presence of conductive hearing loss

3. Painful red tympanic membrane

4. CompleteTM rupture

The correct answer is: Presence of conductive hearing loss

In children with a cholesteatoma, a key finding is the presence of conductive hearing loss. This condition often results from a growth of skin cells and other tissue in the middle ear, which can obstruct the normal movement of the ossicles—the small bones that transmit sound. The conductive hearing loss typically occurs because the cholesteatoma can interfere with the ability of sound to travel through the middle ear, which is essential for the transmission of sound vibrations to the inner ear. While drainage from the ear may sometimes be noted, it is not a universal feature; therefore, absence of ear drainage is not a key finding. Cholesteatomas are generally painless and do not cause a painful, red tympanic membrane. Although a complete tympanic membrane rupture can occur in various conditions, it is not a hallmark of cholesteatoma, which can often develop without perforating the tympanic membrane. The significant impact on hearing makes conductive hearing loss an important and defining feature in the evaluation of cholesteatoma in children.