Cholesteatoma--diagnosing the unsafe ear.

Background: Cholesteatoma represents the most common destructive disease of the ear, affecting the adult and paediatric population alike.
Objective: This article describes the pathogenesis of cholesteatoma and provides a guide to the examination and management of this common disease.
Discussion: Despite advances in surgery and imaging, the diagnosis of cholesteatoma is often delayed. A favourable outcome following treatment of a cholesteatoma rests in part on an early diagnosis, and in reducing significant complications and associated morbidity. Primary care physicians should maintain a high index of suspicion for the presence of cholesteatoma, awareness of otoscopic findings and promptly refer for investigations and management.