Cholesteatoma

An abnormal growth of skin cells in the middle ear that can cause hearing loss and complications

What is Cholesteatoma?

Cholesteatoma is an abnormal collection of skin cells that forms a cyst-like mass in the middle ear, typically behind the eardrum. Despite its name, it contains neither cholesterol nor fat. Instead, it consists of keratin-producing epithelial cells that can grow and expand, potentially causing damage to the delicate structures of the middle and inner ear. If left untreated, cholesteatoma can lead to serious complications including hearing loss, facial nerve paralysis, and brain infections.

Common Symptoms

Cholesteatoma can cause various ear-related and systemic symptoms:

Common Causes

Cholesteatoma can develop through several mechanisms:

Acquired Cholesteatoma

  • Chronic otitis media: Long-term ear infections with eardrum perforation
  • Eustachian tube dysfunction: Poor ventilation of the middle ear
  • Retraction pocket: Inward bulging of the eardrum due to negative pressure
  • Previous ear surgery: Complications from tympanoplasty or mastoidectomy
  • Trauma: Injury to the ear causing eardrum perforation

Congenital Cholesteatoma

  • Embryonic remnants: Retained embryonic tissue in the middle ear
  • Developmental anomalies: Abnormal development during fetal growth

Types of Cholesteatoma

Acquired Cholesteatoma

Develops after birth, usually due to chronic ear infections or Eustachian tube problems. Most common type, typically occurring in adults.

Congenital Cholesteatoma

Present from birth, developing from embryonic tissue remnants. Less common, usually diagnosed in children with intact eardrums.

Disease Progression

Early Stage

Small retraction pocket or perforation with minimal symptoms. May have mild hearing loss or intermittent discharge.

Progressive Stage

Expanding mass causing more significant hearing loss, persistent drainage, and potential erosion of ear bones.

Advanced Stage

Large cholesteatoma with complications such as facial nerve weakness, dizziness, or intracranial spread.

Diagnosis

Cholesteatoma is typically diagnosed through:

  • Otoscopic examination: Visual inspection of the ear canal and eardrum
  • Microscopic examination: Detailed view using an operating microscope
  • Audiometry: Hearing tests to assess the degree of hearing loss
  • CT scan: Imaging to evaluate bone erosion and extent of disease
  • MRI: To differentiate cholesteatoma from other middle ear conditions

Treatment Options

Surgical Treatment

Surgery is the primary treatment for cholesteatoma:

  • Mastoidectomy: Removal of infected mastoid air cells
  • Tympanoplasty: Repair of the eardrum and small ear bones
  • Canal wall up procedure: Preserves ear canal anatomy
  • Canal wall down procedure: Creates larger cavity, easier to clean
  • Combined approach tympanoplasty: Two-stage procedure for extensive disease

Medical Management

  • Antibiotic ear drops: To control infection before surgery
  • Oral antibiotics: For systemic infections
  • Regular cleaning: Removal of debris and discharge
  • Hearing aids: For patients who cannot undergo surgery

Post-Surgical Care

  • Regular follow-up: Monitoring for recurrence
  • Ear cleaning: Professional cleaning of surgical cavity
  • Water precautions: Keeping the ear dry during healing
  • Hearing rehabilitation: Hearing aids or implants if needed

When to Seek Medical Care

Seek immediate medical attention for:

  • Sudden severe hearing loss or complete deafness
  • Facial weakness or paralysis
  • Severe dizziness or vertigo
  • Severe headache with ear pain
  • Signs of meningitis (fever, neck stiffness, confusion)

Schedule routine consultation for:

  • Persistent foul-smelling ear discharge
  • Progressive hearing loss
  • Recurrent ear infections
  • Feeling of fullness in the ear
  • Tinnitus (ringing in the ear)

Potential Complications

  • Hearing loss: Conductive or sensorineural hearing impairment
  • Facial nerve paralysis: Weakness or paralysis of facial muscles
  • Vertigo: Dizziness due to inner ear involvement
  • Meningitis: Brain infection from intracranial spread
  • Brain abscess: Collection of pus in the brain
  • Sigmoid sinus thrombosis: Blood clot in brain venous sinus
  • Erosion of ear bones: Destruction of ossicles affecting hearing

Prevention

  • Treat ear infections promptly and completely
  • Keep ears dry and clean
  • Avoid inserting objects into the ear canal
  • Manage allergies that affect Eustachian tube function
  • Seek medical attention for persistent ear drainage
  • Follow up regularly if you have chronic ear problems
  • Don't ignore hearing changes or ear discomfort

Prognosis

The outlook for cholesteatoma depends on several factors:

  • Early detection: Better outcomes with early diagnosis and treatment
  • Extent of disease: Limited disease has better prognosis
  • Surgical expertise: Experienced surgeons achieve better results
  • Patient compliance: Following post-operative care instructions
  • Recurrence rate: 5-15% chance of cholesteatoma returning

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