Cholesteatoma is an abnormal skin growth in the middle ear behind the eardrum which may be caused by repeated infections or an inward tear of the eardrum which can allow skin into the middle ear. Cholesteatomas often develop into cysts or pouches, shedding layers of old skin that build up inside the middle ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear leading to hearing loss.
Dr. Wayne Berryhill, one of our physicians at Oklahoma Otolaryngology Associates, is referred by physicians throughout the region to perform this delicate surgery. Permanent hearing loss, dizziness and facial muscle paralysis are rare, but can result from continued cholesteatoma growth.
What Causes A Cholesteatoma?
A cholesteatoma can occur due to poor eustachian tube function as well as recurring infections in the middle ear. The role of the eustachian tube is to convey air from the back of the nose into the middle ear which aids to equalize ear pressure. When the eustachian tubes work poorly, perhaps due to symptoms from allergies, a cold, or sinusitis, the air in the middle ear is absorbed by the body, creating a partial vacuum in the ear. The vacuum pressure sucks in a pouch or sac by stretching the eardrum, especially areas weakened by previous ear infections. This can develop into a sac and become a cholesteatoma. A rare congenital form of cholesteatoma formed 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.
How Is Cholesteatoma Treated?
An examination by one of the physicians at Oklahoma Otolaryngology Associates can confirm the presence of a cholesteatoma. Initial treatment may consist of careful cleaning of the ear, antibiotics and ear drops. Therapy aims to stop drainage in the ear by controlling the infection. The growth traits of a cholesteatoma must also be evaluated.
A large cholesteatoma usually requires surgical treatment to protect the patient from serious complications. Hearing and balance tests and CT scans (3-D x-rays) of the mastoid may also be necessary. These tests are performed to determine the hearing level in the ear and the extent of destruction that the cholesteatoma has caused.
The primary purpose of surgery, which is performed under general anesthesia and is commonly performed in an out-patient setting to remove the cholesteatoma which will eliminate the infection and create a dry ear. A second surgery is sometimes necessary both to ensure that the cholesteatoma is totally removed as well as to attempt reconstruction of the damaged middle ear bones in an effort to improve hearing. This operation will attempt to restore hearing and allow the surgeon to inspect the middle ear space and mastoid for residual cholesteatoma. In cases of severe ear destruction, reconstruction may not be possible. Facial nerve repair or procedures to control dizziness are rarely required. For some patients, an overnight stay is necessary and in rare cases of serious infection, prolonged hospitalization for antibiotic treatment may be necessary. After surgery, follow-up office visits are necessary to evaluate results and to check for recurrence. In cases requiring the creation of an open mastoidectomy cavity, office visits every few months are needed to clean out the mastoid cavity and prevent new infections. Some patients will need lifelong periodic ear examinations.
Symptoms and Dangers
Initially, the ear may drain fluid with a foul odor. As the cholesteatoma pouch or sac enlarges, it can cause a feeling of fullness or pressure in the ear, along with hearing loss. An ache behind or in the ear, especially at night, may cause significant discomfort.
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 immediate medical attention. Cholesteatoma is a serious ear condition which can be diagnosed only by medical examination and should not be left untreated. Bone erosion can cause the infection to spread into the surrounding areas, including the inner ear and brain.