What can cause conductive hearing loss in relation to cholesteatoma?

Cholesteatoma can lead to conductive hearing loss primarily due to the invasion of skin into the middle ear. This abnormal growth occurs when skin cells, typically from the outer ear, begin to migrate into the middle ear space. As the cholesteatoma grows, it can erode the surrounding structures, including the ossicles, which are the tiny bones responsible for conducting sound from the outer ear to the inner ear.

When these ossicles become damaged or their movement is impeded, it disrupts the normal transmission of sound, resulting in conductive hearing loss. Additionally, the presence of the cholesteatoma can also block the normal transmission of sound through the ear, compounding the problem.

The other options, such as blockage of the ear canal and perforation of the tympanic membrane, can also lead to conductive hearing loss; however, they are not specific causes related to cholesteatoma. Fluid accumulation in the inner ear is associated with sensorineural hearing loss, which is a different mechanism altogether. Hence, the invasion of skin into the middle ear is the most directly related cause of conductive hearing loss in the context of cholesteatoma.