New review proposes staging framework for aural cholesteatoma: full analysis

Aural cholesteatoma, or tympanokeratoma, is getting a fresh clinical update in veterinary medicine, with a new Veterinary Dermatology review arguing that the condition deserves more structured recognition and management. Published online February 17, 2026, the paper reviews animal cases across species and proposes a staging scheme and treatment principles for companion animals, reflecting what the authors describe as increasing case recognition and growing interest in minimally invasive care. (pubmed.ncbi.nlm.nih.gov)

That matters because cholesteatoma is still considered relatively uncommon in small animal practice, but it can be aggressive when it occurs. Merck Veterinary Manual describes these lesions as keratin-filled, squamous epithelium-lined cysts that expand in the middle ear, most often in dogs and only rarely in cats. They can cause local bone destruction, secondary inflammation, and concurrent or secondary otitis externa or otitis media, with chronic cases sometimes obscured by stenosis, debris, and longstanding ear disease. (merckvetmanual.com)

The new review builds on a body of literature that has gradually clarified both the disease process and the management challenge. Earlier reports in dogs tied cholesteatoma to chronic middle ear disease and documented the need for imaging and histopathology to confirm diagnosis. A 2019 clinical series of 11 dogs suggested that nonsurgical management with video-otoscopic flushing may help selected cases, while a 2016 review concluded that surgical intervention can be curative, especially in less severe disease. At the same time, recurrence has remained a central problem, particularly in advanced or chronic cases where complete removal of keratinizing tissue is difficult. (pubmed.ncbi.nlm.nih.gov)

The feline literature is even thinner, which helps explain the value of a broader update. A 2023 case report described two cats diagnosed with the aid of video-otoscopy and emphasized how little published information exists in that species. In those cats, CT and video-otoscopy helped identify characteristic pearly or friable material in the middle ear, and the authors suggested conservative flushing may have a palliative role when surgery is declined, though they stressed that longer follow-up and repeat imaging are needed because residual material and recurrence remain concerns. (journals.sagepub.com)

Taken together, the literature points to a few practical themes that veterinary teams will recognize: chronic otitis cases with persistent pain, discharge, neurologic changes, or poor response to routine therapy may warrant a higher index of suspicion; CT remains especially important for defining bulla changes and disease extent; and treatment planning often comes down to disease severity, anatomy, recurrence risk, and what pet parents can realistically pursue. The new review’s proposed staging scheme appears aimed at standardizing those decisions and making case discussions more consistent across dermatology, surgery, neurology, and primary care. That last point is an inference based on the paper’s stated goal of proposing staging and treatment principles, rather than a direct quote from the full text. (pubmed.ncbi.nlm.nih.gov)

Why it matters: For veterinary professionals, this is less about a brand-new therapy than about better clinical organization around a hard disease. Earlier recognition could improve case selection for less invasive approaches, while a clearer staging framework could help referral timing, client communication, and follow-up planning. Because recurrence has been reported after both surgical and conservative management, a more standardized approach may also help the field compare outcomes more meaningfully across institutions and species. (pubmed.ncbi.nlm.nih.gov)

Expert commentary tied specifically to the new 2026 review was limited in public sources, but the broader specialist consensus is consistent: cholesteatoma is destructive, often linked with chronic ear disease, and best worked up with advanced imaging and tissue confirmation when feasible. Merck’s updated professional guidance, revised in April 2026, also underscores the need for neurologic examination, imaging, and culture consideration because secondary infection can complicate these cases. (merckvetmanual.com)

What to watch: The next question is whether the review’s staging proposal becomes a practical reference point in referral centers, and whether future case series can show which patients truly benefit from minimally invasive management versus earlier definitive surgery, especially in dogs and the small but growing number of reported feline cases. (pubmed.ncbi.nlm.nih.gov)