What is a Cholesteatoma?
A Cholesteatoma is a growth of skin cells commonly occurring behind the ear drum that can cause damage to the ear drum, erode the middle ear bones and in some cases, impact the inner ear. Untreated cholesteatomas can lead to more serious problems including: chronic ear infections, permanent hearing loss, and dizziness. There are two types of cholesteatomas: acquired and congenital. The most common type is acquired: the cholesteatoma grows over time in a previously healthy ear. In this situation, it starts with a perforation or severe retraction of the ear drum. Congential cholesteatomas are those that an individual is born with and arise from cells that get “misdirected” during fetal development.
What Causes Cholesteatoma?
When the eustachian tube is functioning normally, it equalizes ear pressure by moving air from the back of the throat into the middle ear. Allergies and viruses can impair this process, leading to a partial vacuum in the ear.
Negative pressure stretches the eardrum, creating a pocket or cyst that fills with old skin cells which can become easily infected. In rare cases, the cholesteatoma can be congenital (present at birth).
What Are the Symptoms of Cholesteatoma?
Symptoms of cholesteatoma include drainage from the ear, a feeling of fullness, hearing loss, earache and dizziness. Since these symptoms are also present in other conditions, tests such as audiograms and CT scans can rule out other conditions and confirm the diagnosis. Cholesteatomas continue to grow if not treated and can lead to complications such as:
- Facial paralysis
- Brain abscess
How Is a Cholesteatoma Diagnosed?
A cholesteatoma diagnosis typically begins with a medical history and visual inspection with an otoscope. An audiogram or tympanogram hearing test can help determine the level of hearing loss, and a CT scan of the temporal bone may be ordered. Some of the symptoms that can lead a physician to suspect a cholesteatoma include:
- History of past middle ear infections or fluid buildup
- Discharge from the ear
- Gradual loss of hearing
How Is Cholesteatoma Treated?
An ENT audiologist will determine the size and extent of the cholesteatoma. Their findings will help determine treatment recommendations. Controlling the infection with antibiotics or eardrops is a crucial first step. Surgery is most commonly used to treat a cholesteatoma. Follow-up surgery to ensure the cholesteatoma is gone and to reconstruct damaged middle ear bones may be necessary.