Cholesteatoma: Signs, causes & treatment!

Cholesteatoma is a destructive and expanding growth of cysts (filled with fluid) inside the skin in the middle ear and/or mastoid process.

SIGNS & SYMPTOMS OF CHOLESTEATOMA

  • Ear discharge
  • Hearing loss in the affected ear
  • Swimmer’s ear, inflammation of the ear canal
  • Pain
  • Balance disorder
  • Tinnitus; ringing in the ear
  • Earache
  • Headache
  • Facial nerve weakness

COMPLICATIONS

  • Bleeding from the ear
  • Damage to the ear ossicles
  • Nerve damage
  • Vertigo
  • Loss of hearing
  • Erosion of the thin bone layer that separates the top of the ear from the brain
  • The covering of the bone is left open to infection
  • Brain abscess
  • Sepsis
  • HPV infection.

CAUSES & RISK FACTORS OF CHOLESTEATOMA

  • Congenital cholesteatoma: 
  1. Middle ear epidermal cysts, identified within the intact ear drum.
  2. Grow medial to the ear drum.
  3. No previous history of perforation, discharge or ear surgery.
  4. Hereditary factors.
  • Acquired cholesteatoma:
  1. Keratin accumulates in the pouch of the ear drum which can extend to middle ear space.
  2. Under the influence of ear infection
  3. In the form of retraction pockets which can lead to formation of cholesteatoma.
  4. Epithelium from the outer ear drum grows into the middle ear through a pre-existing perforation.
  • Can also arise due to metaplasia of the middle ear mucosa
  • Implantation following trauma.

DIAGNOSIS

  1. Physical examination of the ear and the ear canal by an ENT specialist. Noting presence of symptoms like imbalance, ear pain, discharge, tinnitus, etc.
  2. CT scan of the ear and neighboring bones & tissues. Images are produced which are studied for ruling out presence of any other serious disease.
  3. MRI done of the ear and brain for detection of damage, if any, to the brain, auditory nerves & cranial nerves & for assessment of damage to the ear.

TREATMENT FOR CHOLESTEATOMA

The treatment for cholesteatoma usually involves surgical procedures. No medications are available to treat this conditions.

Surgeries are:

  • Mastoidectomy: Procedure is performed to remove the mastoid cells in the skull near the inner ear.
  • Tympanoplasty: After a surgical procedure to treat cholesteatoma, certain damage to the ear drum occurs. This damage is assessed & is corrected by reconstruction of the ear canal wall by use of cartilage, fascia, titanium as well as by using the original ear canal skin.
  • Surgical removal of the ear ossicles due to them being exposed after a mastoidectomy. Exposed ear ossicles are prone to infection.