The white mass seen in the postero-superior quadrant of this left middle ear is a cholesteatoma. Note the crust superiorly in the 12 o'clock position which cover over the attic area from which this cholesteatoma...
Note the granulation tissue arising from the attic area of this left middle ear. This "Herodion" signals an underlying cholesteatoma in the middle ear.
Figure showed a small left attic perforation with trapped keratins despite (typical sac with bottle-neck opening), retracted eardrum and grommet in-situ.
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