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Cholesteatoma

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What is Cholesteatoma?

A cholesteatoma is a skin growth that occurs in the middle ear behind the eardrum. It is usually due to repeated infection, which causes an ingrowth of the skin of the eardrum. Cholesteatomas often take the form of a cyst or pouch that sheds layers of old skin that has built up inside the ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear. Hearing loss, dizziness, and facial muscle paralysis are rare but can result from continued cholesteatoma growth.
 
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Causes of Cholesteatoma

A cholesteatoma usually occurs because of poor eustachian tube function as well as infection in the middle ear. The eustachian tube conveys air from the back of the nose into the middle ear to equalize ear pressure. When the eustachian tubes work poorly – perhaps due to allergy, a cold or sinusitis – the air in the middle ear is absorbed by the body, creating a partial vacuum in the ear. The vacuum pressure sucks in a pouch or sac by stretching the eardrum, especially areas weakened by previous infections. This sac often becomes a cholesteatoma. A rare congenital form of cholesteatoma (one present at birth) can occur in the middle ear and elsewhere, such as in the nearby skull bones. However, the type of cholesteatoma associated with ear infections is most common.

The symptoms of cholesteatoma

Luckily, cholesteatomas and the hearing loss they cause are largely treatable through surgery. The only way to be certain about whether or not you or a loved one has a cholesteatoma is to have a medical examination.

  • Fluid draining from the ear (coupled with a strong odor)
  • Ear pressure
  • Earaches in or behind the ear
  • Unsteadiness and sometimes frank vertigo
  • Muscle weakness (on the infected side of the face)

 

Is It Dangerous?

Ear cholesteatomas can be dangerous and should never be ignored. Bone erosion can cause the infection to spread into the surrounding areas, including the inner ear and brain. If untreated, deafness, brain abscess, meningitis, and on rare occasions death, can occur.

Treatment of cholesteatoma

An examination by an otolaryngologist-head and neck surgeon can confirm the presence of a cholesteatoma. Initial treatment may consist of a careful cleaning of the ear, antibiotics, and ear drops. Therapy aims to stop drainage in the ear by controlling the infection. The extent or growth characteristics of a cholesteatoma must also be evaluated.

Large or complicated cholesteatomas usually require surgical treatment to protect the patient from serious complications. Hearing and balance tests and CT scans may be necessary. These tests are performed to determine the hearing level remaining in the ear and the extent of destruction the cholesteatoma has caused

Surgery for Cholesteatoma

Surgery is performed under general anesthesia in most cases and are usually conducted for three important reasons:

  • Remove the ear growth
  • Eliminate infection
  • Create a dry ear

 
In cases of severe ear destruction, ear reconstruction may not be possible. Facial nerve repair or procedures to control dizziness are rarely required. Reconstruction of the middle ear is not always possible in one operation; and therefore, a second procedure may be necessary six to twelve months later. The second operation will attempt to restore hearing and, at the same time, inspect the middle ear space and mastoid for residual cholesteatoma.

Follow-up office visits after surgical treatment are necessary and important, because cholesteatoma sometimes recurs. In cases where an open mastoidectomy cavity has been created, office visits every few months are needed in order to clean out the mastoid cavity and prevent new infections. In some patients, there must be lifelong periodic ear examinations.

If you suspect that you or a loved one is experiencing complications from an ear growth, contact our practice today for a cholesteatoma examination.