1-Differential diagnosis is mostly dependent upon the clinical history of the patient, if the patient got repeated histories of middle ear infection, this favor acquired type, while absence of this history favors congenital type.
2-If you do not have a history, look for mastoid air cells, to search for infection.
Clear mastoid air cells = congenital cholesteatoma.
Infected mastoid air cells = Acquired cholesteatoma.
3-Look also to presence of other congenital abnormality in the middle and/or inner ear.
Presence of other abnormality suggest that cholesteatoma is congenital in origin and vice versa.
2-If you do not have a history, look for mastoid air cells, to search for infection.
Clear mastoid air cells = congenital cholesteatoma.
Infected mastoid air cells = Acquired cholesteatoma.
3-Look also to presence of other congenital abnormality in the middle and/or inner ear.
Presence of other abnormality suggest that cholesteatoma is congenital in origin and vice versa.
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