Cholesteatoma: A Serious Ear Condition
A cholesteatoma is an abnormal skin growth that develops in the middle of the ear, behind the eardrum. It is usually caused by repeat ear infections, which leads to a growth of skin behind the eardrum. Cholesteatomas often manifest as a cyst, or pouch, that sheds layers of skin that builds up. Over time, the cholesteatoma can expand or grow large enough to destroy the surrounding delicate bones of the middle ear. Hearing loss, vertigo, and facial muscle paralysis are rare, but may also result from cholesteatoma growth.
A cholesteatoma usually forms as the result of poor eustachian tube function as well as a middle ear infection. The eustachian tube is a pathway that allows air from the back of the nose into the middle ear to equalize ear pressure. When the eustachian tubes function poorly (due to allergy, a cold, or sinusitis), the air in the middle ear is absorbed by the body, resulting in a partial vacuum in the ear. The vacuum pressure sucks in a pouch or sac by stretching the eardrum, especially areas that have been weakened by previous ear infections. This sac often becomes a cholesteatoma.
Initially, the ear may leak, and the fluid may have a foul odor. As the cholesteatoma pouch or sac enlarges, it can cause a constant full feeling or pressure in the ear, accompanied by difficulty or loss of hearing. Dizziness or muscle weakness on one side of the face (the side of the affected ear) can also occur. Any of these symptoms are good reasons to seek medical evaluation.
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 left untreated, deafness, brain abscess, meningitis, and death (although rare) may occur.
An examination by an otolaryngologist can confirm the presence of a cholesteatoma. Initial treatment may consist of a careful cleaning of the ear by your ENT doctor, followed with an antibiotic and ear drops regimen. Therapy goals are to stop drainage in the ear by controlling the infection. The extent or growth characteristics of a cholesteatoma must also be evaluated.
Cholesteatomas typically require surgical intervention to protect the patient from serious complications. Hearing tests and CT scans may be necessary to determine the exact size, location, and effect of the cholesteatoma. These tests are performed to determine the hearing level remaining in the ear and the extent of destruction the cholesteatoma has caused.
Surgery to remove the cholesteatoma and correct any damage is performed under general anesthesia. The primary purpose of the surgery is to remove the cholesteatoma, clear the infection, and leave a dry, safe ear. Hearing preservation or restoration is the second goal of surgery. In cases of severe ear damage, reconstruction may not be possible. Reconstruction of the middle ear is usually not completed during a single operation; a second operation may be performed 6 to 12 months after the first. The second operation will attempt to restore hearing and, at the same time, inspect the middle ear space and mastoid for residual cholesteatoma.
The procedure is generally performed as an outpatient surgery but sometimes requires an overnight stay. In rare cases of serious infection, prolonged hospitalization for antibiotic treatment may be necessary. Downtime from work or school lasts one to two weeks.
After surgery, follow-up office visits 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, lifelong periodic ear examinations are recommended.
Cholesteatoma is a serious but treatable ear condition which can only be diagnosed by medical examination. A persistent earache, ear drainage, ear pressure, hearing loss, dizziness, or facial muscle weakness signals the need for evaluation by an otolaryngologist. At Alpine ENT, we are experts in cholesteatoma and can help you with your ear problems. Schedule your consult today!