What is a cholesteatoma?
is a skin growth in an abnormal location. It is most commonly seen in the
middle ear and mastoid. Cholesteatoma is most often the result of chronic
infection. This process results in ingrowth of the skin of the eardrum and ear
canal into the middle ear and mastoid. Over time, cholesteatomas tend to grow
and destroy surrounding structures. While cholesteatomas are not tumors, they
share similar characteristics. They can destroy bone, be a seed for infection
and may recur. Initially, cholesteatoma will destroy the middle ear hearing
bones. If allowed to grow however, it may invade the inner ear, resulting in
hearing loss, dizziness, and facial paralysis. If left uncontrolled,
cholesteatoma may even invade the skull, increasing the risk of infection in
this area, leading to meningitis and brain abscess.
Cholesteatoma typically occurs as a result of poor
eustachian tube function. The eustachian tube is the structure that passes from
the middle ear to the back of nose, which allows one to equalize ear pressure
("pop the ear"). In some individuals, this structure does not function well.
This will result in a vacuum effect in the middle ear. This then sucks in the
skin of the ear canal and eardrum, escpecially if it has been weakened by
previous middle ear infections. As the skin begins to accumulate, a cystic
structure develops, forming the cholesteatoma. A rare form of cholesteatoma may
be congenital, which may occur anywhere in the middle ear and mastoid.
What are the symptoms of cholesteatoma?
develop as the cholesteatoma grows. The infection will most often be
characterized by drainage through the ear canal. As the cholesteatoma enlarges,
hearing will decrease. If left untreated, symptoms of dizziness and pain may be
seen. In advanced cases, weakness of the facial muscles on the involved side
What is the treatment for cholesteatoma?
Cholesteatoma is usually diagnosed by examination of the ear. A hearing
test (audiogram) is usually performed. In some cases, a C-T scan may be
obtained to determine the extent to the cholesteatoma.
treatment of cholesteatoma is directed at controlling any infection. This
involves cleaning the ear, antibiotic ear drops and at times, oral antibiotics
as well. The goal of this therapy is to decrease or stop the drainage in
preparation for definitive treatment. Definitive treatment of cholesteatoma
requires surgery. The procedure most often performed is a tympanomastoidectomy.
This is done under general anesthesia. The purpose of the operation is to
remove the cholesteatoma and rebuild the eardrum to prevent the possibility of
recurrence. The procedure is performed through an incision in the crease behind
the ear. The operation is always done with the operating microscope. During
surgery, the mastoid is opened and the eardrum elevated. Once all disease is
removed, the eardrum and any bony defects of the ear canal are rebuilt. The
eardrum is reconstructed with a graft, most often obtained from the lining of
muscle (fascia) behind the ear. If there is a defect of the ear canal adjacent
to the eardrum, it may be reconstructed with cartilage.
Most often, the
cholesteatoma will result in destruction of one or more of the three middle ear
hearing bones. While the hearing bones can be rebuilt, it is typically
performed at a second stage. This is staged for two reasons. First,
cholesteatoma has a recurrence rate of about 15%. A second procedure performed
through the ear canal 6 to 12 months after the initial procedure will allow the
surgeon to remove any recurrent disease. Secondly, at the time of the initial
procedure, the ear is infected. The reconstruction of the middle hearing bones
is performed with a prosthesis (artificial bone). Introduction of a prosthesis
into an infected middle ear at the time of the initial procedure may result on
rejection of any reconstructive materials. Therefore, the reconstruction of the
middle ear hearing bones is performed at the second stage, when the middle ear
is dry and noninfected.
If the cholesteatoma is extensive, the
tympanomastoidectomy may require removal of the ear canal. This will allow for
the mastoid to be visualized through the opening of the ear and minmize the
possibility of recurrence. This will result however, in an open mastoid cavity,
requiring periodic care by the surgeon.
A tympanomastoidectomy is
usually a 1 - 2 hour procedure. Patients may discharged later that day or the
next morning. The second stage procedure is usually performed on an outpatient
basis. The recovery from the surgery is about one week. Since cholesteatoma may
recur, it is important for the patient to follow up in the office on a regular