What is a
cholesteatoma?
A cholesteatoma is a skin growth that occurs
in an abnormal location, 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 builds 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.
How does it
occur?
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 ("clear the
ears"). 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,
and a partial vacuum results 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.
What are
the symptoms?
Initially, the ear may drain, sometimes with
a foul odor. As the cholesteatoma pouch or sac
enlarges, it can cause a full feeling or
pressure in the ear, along with hearing
loss. (An ache behind or in the ear,
especially at night, may cause significant
discomfort.) Dizziness, or muscle weakness on
one side of the face (the side of the infected
ear) can also occur. Any, or all, of these
symptoms are good reasons to seek medical
evaluation.
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 rarely death can occur.
What
treatment can be provided?
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, x-rays of the mastoid (the skull
bone next to the ear), and CAT scans (3-D
x-rays) of the mastoid 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 is performed under general anesthesia
in most cases. The primary purpose of the
surgery is to remove the cholesteatoma and
infection and achieve an infection-free, dry
ear. Hearing preservation or restoration is the
second goal of surgery. In cases of severe ear
destruction, 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 operation may
be performed 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.
Admission to the hospital is usually done the
morning of surgery, and if the surgery is
performed early in the morning, discharge maybe
the same day. For some patients, an overnight
stay is necessary. In rare cases of serious
infection, prolonged hospitalization for
antibiotic treatment may be necessary. Time off
from work is typically one to two weeks.
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.
Summary
|
Cholesteatoma is a serious but
treatable ear condition which
can only be diagnosed by medical
examination. Persisting earache,
ear drainage, ear pressure,
hearing loss, dizziness, or
facial muscle weakness signals
the need for evaluation by an
otolaryngologist-head and neck
surgeon. |
|
