Overview

Cholesteatoma is a type of non-cancerous growth that can occur in the middle ear, typically as a result of a history of chronic ear infections. The growth can lead to a variety of symptoms, including hearing loss, drainage from the ear, and dizziness, and if left untreated, it can cause serious complications such as infection, meningitis, or brain abscess.

While cholesteatoma can be a serious condition, with appropriate treatment and ongoing care, many people are able to achieve good outcomes and preserve their hearing and ear function.

 

What is a Cholesteatoma?

A cholesteatoma is a noncancerous growth of skin cells that can develop in the middle ear, behind the eardrum. It is a sac-like structure that can cause damage to the structures of the ear and may lead to hearing loss. Cholesteatomas can be either congenital (present at birth) or acquired (developed later in life). Congenital cholesteatomas are rare and usually discovered during early childhood, while acquired cholesteatomas typically develop as a result of chronic ear infections or trauma to the eardrum. Symptoms of cholesteatoma may include hearing loss, ear pain, discharge from the ear, dizziness, and facial muscle weakness. 

 

What causes an Ear Cholesteatoma?

An ear cholesteatoma is a non-cancerous but potentially dangerous skin growth that can occur in the middle ear, behind the eardrum. It is typically caused by repeated infections, trauma to the ear, or a defect in the structure of the ear.

One common cause of ear cholesteatoma is chronic ear infections, which can cause the lining of the middle ear to thicken and produce a cyst-like growth. This growth can continue to grow and eventually erode the bones of the ear, causing hearing loss, dizziness, and other symptoms.

Other possible causes of ear cholesteatoma include a history of ear surgery, such as a mastoidectomy or tympanoplasty, which can leave behind a small piece of skin that can become trapped and grow into a cholesteatoma. In some cases, a congenital abnormality or structural defect in the ear may also lead to the formation of a cholesteatoma.

If you suspect that you may have an ear cholesteatoma, it is important to seek medical attention promptly. An ear, nose, and throat (ENT) specialist can diagnose and treat this condition, which may involve surgical removal of the growth and, in some cases, reconstruction of the affected ear.

 

What are the Symptoms of Cholesteatoma?

The symptoms of cholesteatoma can vary depending on the severity and location of the growth.

Some common symptoms include:

1. Ear pain or discomfort
2. Foul-smelling discharge from the ear
3. Hearing loss, which can range from mild to severe
4. Tinnitus, or ringing in the ear
5. Vertigo or dizziness
6. Pressure or fullness in the ear
7. Facial weakness or paralysis (in rare cases)

These symptoms may develop gradually or suddenly, and they may come and go. If you experience any of these symptoms, it is important to seek medical attention as soon as possible, as cholesteatoma can lead to serious complications such as hearing loss and infection of the bone surrounding the ear. An ear, nose, and throat (ENT) specialist can perform a physical examination of the ear and order imaging tests to confirm the diagnosis and develop a treatment plan.

 

How is a Cholesteatoma diagnosed?

A cholesteatoma is typically diagnosed through a combination of a physical examination and imaging tests. An ear, nose, and throat (ENT) specialist will begin by examining the ear canal and eardrum using a lighted instrument called an otoscope. If a cholesteatoma is suspected, the doctor may then perform a more detailed examination of the middle ear using a microscope or endoscope.

Imaging tests such as a CT scan or MRI may also be ordered to help confirm the diagnosis and determine the extent of the cholesteatoma. These tests can show the location and size of the growth, as well as any damage to the bones or other structures of the ear.

In some cases, a biopsy of the tissue may be necessary to confirm the diagnosis and rule out other conditions, such as ear cancer.

It is important to seek medical attention promptly if you experience symptoms such as ear pain, discharge, or hearing loss, as early diagnosis and treatment can help prevent complications and preserve your hearing.

 

What are the Treatment Options for Cholesteatoma?

The treatment of cholesteatoma usually involves surgery to remove the growth and prevent further damage to the ear. The type of surgery depends on the size, location, and severity of the cholesteatoma.

1. Tympanoplasty: This surgery is used to repair a hole in the eardrum and remove a small cholesteatoma. During the procedure, the surgeon removes the cholesteatoma, repairs the hole in the eardrum, and reconstructs the middle ear structures as needed.
2. Mastoidectomy: This surgery is used to remove a larger cholesteatoma that has spread to the bone behind the ear. During the procedure, the surgeon removes the cholesteatoma and any damaged bone, reconstructs the middle ear structures, and cleans out any infection.
3. Canal wall up or canal wall down procedure: These are variations of the mastoidectomy, where the surgeon leaves the canal wall intact (canal wall up) or removes part of it (canal wall down) to prevent the cholesteatoma from recurring.
4. Atticotomy: This surgery is used to remove a cholesteatoma that is located in the upper part of the middle ear. The surgeon removes the cholesteatoma and any damaged bone, and reconstructs the middle ear structures.

In some cases, antibiotic eardrops may be prescribed to help control infection before or after surgery. After surgery, follow-up visits with an ear, nose, and throat (ENT) specialist are needed to monitor healing and prevent complications.

It is important to seek medical attention promptly if you experience symptoms of cholesteatoma, as early diagnosis and treatment can help prevent complications and preserve your hearing.

 

What are the complications of large or complex cholesteatomas?

Large or complex cholesteatomas can lead to several complications, including:

1. Hearing loss: Cholesteatomas can cause damage to the delicate structures of the ear, leading to hearing loss that can be mild to severe.
2. Recurrence: Cholesteatomas have a high rate of recurrence, especially if not completely removed during surgery.
3. Facial paralysis: In rare cases, cholesteatomas can damage the facial nerve, leading to weakness or paralysis of the muscles on one side of the face.
4. Meningitis: If the infection spreads beyond the ear, it can cause inflammation of the lining of the brain, leading to meningitis.
5. Brain abscess: In rare cases, cholesteatomas can lead to the formation of a collection of pus in the brain, known as a brain abscess.
6. Dizziness and balance problems: Cholesteatomas can damage the inner ear structures responsible for balance, leading to dizziness, vertigo, and balance problems.
7. Spread of infection: Untreated cholesteatomas can spread to other parts of the ear, causing infections that can lead to serious complications.

 

Is there anything I can do to prevent a Cholesteatoma?

Unfortunately, there are no specific measures you can take to prevent the development of a cholesteatoma. However, you can take steps to reduce your risk of developing an ear infection or other ear problems that may lead to a cholesteatoma, including:

1. Avoid exposing your ears to loud noises, such as music or machinery, for extended periods of time.
2. Protect your ears when swimming or bathing by using earplugs or a swim cap.
3. Keep your ears dry and avoid using cotton swabs or other objects to clean them, as these can push earwax deeper into the ear canal and cause damage.
4. Seek prompt medical attention if you develop symptoms of an ear infection, such as ear pain, discharge, or hearing loss.
5. Visit your doctor or an ear, nose, and throat specialist (ENT) for regular check-ups, especially if you have a history of ear problems or infections.

While these measures cannot guarantee that you will never develop a cholesteatoma, they can help reduce your risk of developing ear infections or other ear problems that can lead to complications. If you do experience symptoms of a cholesteatoma, seek medical attention promptly to ensure early diagnosis and treatment.

 

What is the outlook for people with ear Cholesteatomas?

The outlook for people with ear cholesteatomas can vary depending on the size, location, and severity of the growth, as well as the extent of any damage that may have occurred to the ear structures. However, with prompt diagnosis and appropriate treatment, many people are able to achieve good outcomes.

Surgery to remove the cholesteatoma is typically effective in preventing further damage to the ear and reducing the risk of complications such as hearing loss, infection, or meningitis. In some cases, additional surgeries or ongoing medical management may be needed to address any ongoing problems or complications.

After treatment, regular follow-up visits with an ear, nose, and throat (ENT) specialist are typically recommended to monitor healing and ensure that any new problems are addressed promptly.

In general, the outlook for people with cholesteatomas is best when the growth is detected and treated early. Delayed treatment can lead to more extensive damage and a higher risk of complications, so it is important to seek medical attention promptly if you experience symptoms of a cholesteatoma.

 

Cholesteatoma in children

Cholesteatoma is less common in children than in adults, but it can still occur in children of any age. Children with cholesteatomas may experience symptoms such as ear pain, hearing loss, drainage from the ear, or a feeling of fullness in the ear. Younger children may be irritable, cry more than usual, or pull at their ear.

Diagnosing and treating cholesteatomas in children requires special care, as their ear structures are smaller and more delicate than those of adults. Children may require sedation or general anesthesia during diagnostic procedures and surgical treatment, and the surgery may need to be performed in stages to avoid damaging the delicate structures of the ear.

 

Conclusion 

In conclusion, cholesteatoma is a type of non-cancerous growth that can occur in the middle ear. It is often caused by a history of repeated ear infections, and can lead to a variety of symptoms including hearing loss, drainage from the ear, and dizziness. If left untreated, cholesteatomas can cause serious complications such as infection, meningitis, or brain abscess.

While cholesteatoma can be a serious condition, with appropriate treatment and ongoing care, many people are able to achieve good outcomes and preserve their hearing and ear function. If you suspect that you or your child may have a cholesteatoma, it is important to seek medical attention promptly to ensure early diagnosis and appropriate treatment.