What Are the Treatments for Cholesteatoma?

A cholesteatoma is a potentially dangerous growth in the ear. It is usually infected and also excretes enzymes that erode the bones so it can result in hearing loss or even infection in the brain, making it a potentially serious condition that needs to be diagnosed early and treated aggressively.

Definition

• A cholesteatoma is a growth of skin in the middle ear that causes dead cells to accumulate and become infected. The most common cause of a cholesteatoma is a dysfunctional eustachian tube. If the eustachian tube does not regulate air pressure properly, the eardrum begins to be pulled toward the inner ear and a cholesteatoma forms where the eardrum is pulled in. If the eardrum becomes perforated due to an infection or trauma, skin from the outer surface of the eardrum can grow through the perforation into the middle ear and form a cholesteatoma. There is also a congenital cholesteatoma, which happens when a baby is born with a remnant of skin that is trapped in the middle ear.

Symptoms

• The first symptoms are drainage from the ear and a loss of hearing. Dizziness, earache, headache, and pain around the ear may also be present.

Diagnosis

• The build-up of skin or a perforation may be visible during an ear exam. A CAT scan can be used to visualize how far the cholesteatoma has grown and whether it has involved the inner ear or brain. A hearing test will also be performed to see if the cholesteatoma has caused hearing loss.

Treatment

• If the cholesteatoma is small, there's no infection and no hearing loss has occurred, it is possible that the dead skin from the cholesteatoma can be cleaned out in the doctor's office and a close watch kept to be sure the condition doesn't return. Since they are typically infected and can damage hearing, surgery is usually required to stop the infection and then rebuild any damaged structures.

  The surgical process is determined as physicians access the cholesteatoma and discover how large it is and exactly what bones are involved. A small cholesteatoma may be completely removed in one piece and reconstruction of the eardrum can be done at the same time. If the cholesteatoma has to be removed in pieces, then a second surgery will be scheduled a few months later to finish removing any skin growth and repair the ear. It is possible that during surgery physicians will discover that the cholesteatoma is extensive and has attached to the inner ear or a nerve. In that case a mastoidectomy is performed to remove infection, to ensure that all of the cholesteatoma is removed and the ear is clean.

Complications

• Cholesteatomas can erode the bones in the ear and cause hearing loss. They can also cause damage to other bones in the area, including one over the facial nerve and bones in the inner ear. The result can be facial paralysis or additional hearing loss and dizziness. If the infection is not treated, it can spread into the veins, causing fluid to build up around the brain or meningitis.