Risks of Cholesteatoma

Cholesteatoma is a disease of the ear. A non-cancerous skin cyst grows into the mastoid and middle ear, causing tissue to erode and destroying the ear. It's very important to treat cholesteatoma to ensure the preservation of hearing.

How Cholesteatoma Forms

• The ear canal and the outer surface of the eardrum are normally lined with skin. Dead skin cells compose the outermost layer of skin, and are being sloughed off constantly and are discharged with earwax. When the dead cells accumulate in the middle ear and can't be discharged, an infection can occur, and with it, occasional drainage from the ear. Enzymes produced by the accumulation of dead cells can cause the destruction of bone.

Complications of an Untreated Cholesteatoma

• If the bones behind the eardrum erodes, it can cause a conductive hearing loss, which is a problem in conducting sound waves through the outer ear, eardrum or middle ear. The bone over the facial nerve can also be destroyed, resulting in facial paralysis. The inner ear can also be partially destroyed. This can cause dizziness and sensory hearing loss.

  Ear infections occur commonly with cholesteatoma leading to a foul smelling discharge, and possibly containing blood. Systemic antibiotics (by mouth) or as ear drops can help control the infection, though they will not cure the cholesteatoma. If an infection remains untreated, it can spread into the veins (lateral venous sinus) that carry blood from the brain to the heart. This large vein can become obstructed, causing a buildup of fluid inside the skull called hydrocephalus. Meningitis can also occur if the infection also spreads to the covering of the brain. A brain abscess can result in rare circumstances.

Cholesteatoma Surgery

• There are several types of cholesteatoma surgery, depending on the location. Tympanoplasty involves the middle ear, or the area of the ear behind the ear drum where the ossicles (bones of hearing) are located. Mastoidectomy is performed in the mastoid, where the disease may occur. Tympanomastoidectomy involves both the eardrum and mastoid. Ossiculoplasty is the repair or reconstruction of the ossicles. Many techniques and many types of prostheses can be used for reconstructing the ossicles.

  There are two basic approaches for the ear surgery. A transcanal surgery is performed through the ear canal. A postauricular surgery is performed by making an incision behind the ear, and then moving the ear forward to expose the mastoid and middle ear. These approaches are combined in some cases to allow for best exposure. The approach used depends in part on the location and size of the cholesteatoma, and the surgeon's preference and experience.

  When the surgeon decides what procedure is best, a number of factors have been considered. These may include the extent of the cholesteatoma and the size of the mastoid. The surgeon primarily wants to remove the disease, then restore or maintain hearing.