Cholesteatoma

What Is a Cholesteatoma?

A cholesteatoma is a skin growth that occurs in an abnormal location, namely, the middle ear behind the eardrum and/or the mastoid bone behind the ear. 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 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. Dizziness and facial paralysis are rare but can result from continued cholesteatoma growth.

Normal Ear Drum

Cholesteatoma

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. 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?

The most common symptom is that of recurrent ear drainage. The ear drainage sometimes has a foul odor. Drainage occurs because the cholesteatoma traps bacteria, which leads to recurrent ear infections. As the cholesteatoma enlarges, it can cause a full feeling or pressure in the ear, along with hearing loss. 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 prompt medical evaluation.

Is It Dangerous?

Ear cholesteatomas can be dangerous and should never be ignored. Cholesteatomas can cause destruction of surrounding bone through bone erosion. The cholesteatoma may destroy the delicate middle ear bones or, less commonly, the cholesteatoma may erode the surrounding structures such as the inner ear or brain. If untreated, deafness, brain abscess, meningitis, and rarely death can occur.

What Treatment Can be Provided?

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. After the infection is controlled, surgical removal is often recommended to prevent serious complications. A hearing test is performed, to help estimate if there is any damage to the middle ear bones or inner ear. A CT scan is often recommended to determine the size of the cholesteatoma. Surgery is performed under general anesthesia in most cases. The primary purpose of the surgery is to remove the cholesteatoma and achieve an infection-free, dry ear. Hearing preservation or restoration is the second goal of surgery. In most cases, patients are discharged on the same day of surgery.