Cholesteatoma


Last Updated December 20th, 2021

Overview

Cholesteatoma is an abnormal non-cancerous skin growth or skin cyst that develops behind the eardrum, in the middle section of the year. Recurring middle ear infections causes the dead skin to accumulate and damage the sensitive bones behind the ear.

Cholesteatoma affects hearing, balance and the working of facial muscles. It starts as a build-up of earwax and skin causing a cyst on the eardrum. Overtime, this can spread to the bone behind the ear, known as a mastoid bone.

In certain cases, cholesteatoma is due to a birth defect. Congenital cholesteatoma form in the middle ear or in other areas of the ear. In such cases, children develop cholesteatoma from a very young age. Most often, it occurs due to repeated infections in the middle ear. The good news is cholesteatoma is not cancerous but if it is not treated on time, it causes problems like hearing loss, which is unfortunately irreversible.

Who are at risk of cholesteatoma?

  • Men are more prone to cholesteatoma compared to women.
  • Children with undiagnosed cholesteatoma are at risk of hearing loss by early adulthood. Late childhood or early adolescence is the appropriate time for surgery.
  • People with recurrent ear infections causing fluid discharge are at risk of developing cholesteatoma.

What Causes cholesteatoma?

Medical experts have pointed out the factors that cause cholesteatoma which leads to hearing loss if not treated in time. Some of the causes are as follows:

  • Blockage of the Eustachian tube: Eustachian tube extends from the back of the nose to the middle of the ear. It allows air to flow through, thereby balancing ear pressure. This conditioncausesa partial vacuum in the middle ear creating a cyst. This can grow considerably as it starts collecting old skin cells, fluids, and waste materials and turns to cholesteatoma. The Eustachian tube cannot function well due to the blockage.
  • Sinus infections: Nasal cavities get infected, swollen and inflamed.
  • Chronic ear infections: Fluid discharge and inflammation.
  • Colds: Infection of the nose and throat
  • Allergies: Similar to cold with irritation in the throat
  • Birth defects: In rare cases,a cholesteatoma may form in the developmental stage of the fetus.Part of the lining of the ear is trapped as the bone grows. This condition can be detected during childhood.

Symptoms of Cholesteatoma

Patients experiencing cholesteatoma observe the following symptoms, which are mild initially, but increase as the cysts becomes large. Cysts are diagnosed at an advanced stage leaving the doctors with no choice but to remove it surgically.

  • Foul-smelling fluid from the infected ear
  • Enlarging cyst creates a sense of pressure causing discomfort
  • Severe pain and swelling in the ear
  • Hearing loss
  • Dizziness
  • Vertigo, facial muscle paralysis occurs as the cyst grows unchecked
  • Recurring ear infections

You need to consult an ENT specialist or Otolaryngologist immediately if any of the above symptoms are present.

Types of cholesteatoma

 Cholesteatoma is categorized under the following three types.

  • Congenital cholesteatoma: Is rare, and occurs during the development of the embryo when squamous epithelium residue remains in the middle ear. The tympanic (middle ear) membrane is intact.
  • Primary acquired cholesteatoma or retraction cholesteatoma: This happens when there is a malfunction in the middle ear due to low pressure in the middle ear cells. The tympanic membrane creates what is known as a retraction pocket. This occurs in the pars flaccid region of the tympanic membrane, which is very limp. Squamous epithelium collects in this retraction pocket leading to the formation of cholesteatoma after a few years.
  • Secondary acquired cholesteatoma: This is caused because of a pre-existing peripheral defect in the tympanicmembrane that allows the epithelium to penetrate into the middle ear.

Complications of cholesteatoma

If untreated it can lead to a lot of complications, which can adversely affect victims ‘quality of life.

  • Chronic infection can lead to hearing loss and deafness. This is because of damage to the ossicular chain, so the sound is no longer transmitted to the inner ear.
  • Cholesteatoma can erode bone, in which case the infection spreads to the inner ear or brain causing more complications like meningitis, brain abscess, dizziness (vertigo), facial paralysis and even death
  • The cysts if untreated spread into the face as it continues to grow to cause facial weakness
  • In some cases cholesteatoma continues to grow even after surgery, this is usually with respect to large cysts
  • Congenital aural stenosis carries a much greater risk of cholesteatoma as compared to congenital aural atresia

Diagnosis

An audiologist and an ENT specialist diagnose cholesteatoma using any or if required all of the following methods.

  • Ear Microscopy:This method helps find out the defect in the tympanic membrane, and the extent of bone erosion of the wall of the ear canal, close to the eardrum.
  • CT Scan (computer tomography): The extent of bone loss is determined accurately, this can aid the course of treatment. It helps locate the size and placement of the cholesteatoma.
  • Hearing Test (audiogram): Since hearing loss is the major issue in cholesteatoma, this test will help determine the extent of hearing
  • MRI (magnetic resonance imaging): If the CT scan reports recommend a closer view, MRI is performed to investigate if the infection has spread to the brain. The growth traits of cholesteatoma are clearly visible in an MRI.

Treatment for cholesteatoma

Most often, treatment for cholesteatoma is surgical intervention. The infection gets resistant to antibiotics leaving surgery as the only option.

  • As a first step, the ENT specialist evaluates the extent of damage and prescribes medication to reduce the infection and inflammation. The drain from the ear has to stop and it must dry completely. Surgery can be performed only after the inflammation and infection has reduced
  • The non-surgicaloption is possible only in the early stages but most often cholesteatoma is diagnosed at a later stage, leaving surgery as the only method of treatment
  • Type of surgery depends on the part of the ear that is infected. Sometimes clinical examination helps detect the location of cholesteatoma, whereas at other times an MRI or a CT scan is performed to correctly evaluate the extent of damage
  • The main purpose of the surgery is to remove the dead skin, clear the infection and make the area dry before any surgical intervention
  • Surgery involves reconstructing the eardrum, removing the bone behind the ear. In certain cases, a second surgery is needed to make sure the entire cholesteatoma is removed before reconstructing the bones
  • The second surgery is performed in six to twelve months after the first surgery. Sometimes there is a temporary hearing loss if the reconstruction of the hearing bone is delayed
  • In general, this surgery is performed as an outpatient setting. In rare cases of severe infection, prolonged hospitalization is needed with antibiotic treatment
  • Cholesteatoma surgery is performed under general anesthesia. At times it is done with intravenous sedation and local anesthesia
  • Follow up visits are mandatory to clean the ear and recheck hearing
  • Patients can get back to work typically in one or two weeks. If the work involves strenuous activity then aperiod of rest for three to four weeks after surgery may be necessary
  • Cholesteatoma requires monitoring and follow up to check for any recurrence of infection

Are antibiotics a cure for cholesteatoma?

  • In most cases, surgery remains the main solution to cure cholesteatoma
  • Antibiotics can reduce the infection but cannot remove or stop the formation of cysts

 Risks involved with surgery

Patients and family must know the risks of cholesteatoma surgery.

  • Facial paralysis the nerve that passes through the ear may get affected. This causes restricted movements in the face that can affectthe closing of the eye, smile, and raising the forehead. This is either partial or complete which happens soon after surgery or after some period. Recovery can be partial or complete
  • Tinnitus (noises in the ear) can occur after the surgery, though it is an uncommon problem. Some patients complain of hearing noises and discomfort in the ear post-surgery
  • Dizziness is a complaint from a few patients, which usually resolves within a day of surgery. It is unlikely to prevail as a persistent problem. This is due to the effect of anesthesia
  • Hearing loss: there is a slight chance of hearing loss which can be permanent
  • Taste abnormalities a small nerve that is responsible for the taste and salivary function passes through the ear. After surgery, some patients experience an abnormal taste and dryness of the mouth. This improves over time.
  • Infection is a common risk associated with any surgery. Anesthesia-related complications, along with otological risks.

However, these risks are minimized if the surgery is performed by an experienced otolaryngologist. The success of the surgery depends also on postoperative care. Following the instructions after surgery is crucial in the healing process.

Prognosis of cholesteatoma

With successful removal of the cholesteatoma, chances of recovery are good. Many patients are completely treated with cholesteatoma. Prognosis also depends on the extent of complications over the course of the condition. Successful surgery can completely eliminate the large cysts too. Postoperative follow up medical consultation is very crucial to evaluate the condition

Prevention

Cholesteatoma cannot be completely prevented but its intensity can be reduced by seeking timely medical assistance

  • Awareness among parents about cholesteatoma reduces the risk of hearing the loss in children
  • Treating ear infections quickly and thoroughly helps monitor the formation of cysts
  • The occurrence of cholesteatoma is reduced with local treatment
  • Vitamin A has proven to be very effective in treating hyperkeratosis, this can be a therapeutic option for cholesteatoma as well
  • Research has shown that Cortisporin and Vitamin A is considered effective as local treatment
  • Always consult an ENT specialist for better diagnosis and treatment.

 

 

Dos and Don'ts

Dos
  • Consult an ENT specialist if you suffer from constant ear infections
  • Follow the advice of the doctor strictly with respect to ear infections
  • Discuss all the risk factors associated with the surgery
  • Consult an experienced surgeon as this reduces the risks involved with surgery
Don'ts
  • Use over the counter medicines as this will lead to further complications
  • Remove the wax or fluid discharge by yourself, this causes damage to the eardrum
  • Neglect an ear infection especially if it is occurring very often.

 

 

 

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Barium Enema Barium enema is also known as colon x-ray. Here, the patient is asked to consume small amount of…
Ca 19.9 test
CA19.9 Test CA 19.9 is a cancer antigen that exists on the surface of cancer-causing cells. The levels of CA…
apolipoprotein a1 test
Apolipoprotein -A1 (APO-A1) Test Apolipoprotein A-I (Apo-A1) constitutes 70% of protein content in high-density lipoprotein (HDL) and helps in lipid metabolism.
High Fiber Diet – Fire up your fiber intake for these health benefits! Regular bowels, healthy detox, higher immunity, and guaranteed weight loss - a high fiber diet can bring all…
Oil of Oregano: The one-stop essential oil you’ve been looking for Are you plagued by a weak immune system? High body inflammation accompanied by pain and infections? Why not…
malarial antigen test
Malaria Antigen Test A malaria antigen test is a rapid diagnostic test (RDT) that can detect malarial antigens (proteins) in your…
CERULOPLASMIN- triple marker
Triple Marker Test A triple marker test is an important prenatal test that is performed to detect the presence of chromosomal…
EMG electromyography
EMG- Electromyography EMG detects the presence, location, and extent of diseases that damage the nerves such motor neuron disease. Electromyography…
Hibiscus: Nourish your beauty and health with these vibrant blooms Hibiscus is a trumpet shaped flower found abundantly in tropical countries. It has been historically used for its…
Helicobacter pylori IGA
Helicobacter Pylori – IgA Test The H.pylori IgA test is a blood test used to identify the level of IgA antigen in the…
Goji berry: A traditional Chinese berry that packs the best of antioxidants Goji berry is an ancient berry that is considered to be power-packed with nutrients and antioxidants. Which means…
amylase test
Amylase Test Amylase test is done by checking the level of this protein in the blood sample and also in…
ureteroscopy
Ureteroscopy Ureteroscopy is the diagnostic procedure which is used for the detection of the kidney stones in addition to…
6 arguments in favour of glucosamine and where can you find it Studies have shown that glucosamine works by preventing the breakdown of cartilage of the joints. This is usually…
Spinach: The ultimate way to boost health with this green superfood! Spinach is a green superfood that ranks high in both taste and nutrition. Read more to discover how…
Diabetes blood test
Diabetic Profile The diabetic profile is a set of tests used for testing and monitoring the various kinds of Diabetes…
Cordyceps: How the Caterpillar fungus works as a proven cancer-shield Strange as it may sound, but cordyceps or "caterpillar fungus", a fungus variety native to the Himalayas may…
cystatin C
Cystatin C Test Cystatin C is a specific single-chain protein that is found in body fluids and is a biomarker for…
hYdroxycut pills
Hydroxycut: How safe are these so-called weight loss supplements? Hydroxycut is a blend of several different ingredients formulated to promote weight loss; powered by a key weight…
kefir bottle
Kefir: Top reasons why this probiotic drink should be consumed by you Yet another remarkable fermented food, kefir is a much healthier version of yogurt. These chewy white grains can…
Period sanitary napkin-menstruaion-blood-colors
Period blood – what it says about your health Your period blood color and consistency indicate what is happening in your body. Is your blood bright red…
vital organ diseases
Common diseases that could cripple your vital organs Brain, heart, kidney, lungs, and liver - these vital organs are indeed vital for your survival. However, these…
Fibromyalgia fatigue
HCG Diet: The dangers of using this diet to lose weight HCG is a natural hormone produced by both men and women that corresponds to fertility. But how is…
How to correctly perform nasal irrigation using a Neti Pot? Neti pot has been a part of Ayurveda since centuries. This ancient tool is extremely effective in treating…
Balneotherapy jacuzzi
5 things you didn’t know about balneotherapy and how you can do it at home Sauna baths have been popular since a long time. But how much more beneficial can balneotherapy be as…
cytomegalovirus iGG
Cytomegalovirus (CMV)- IgG Test The cytomegalovirus IgG is the immunoglobulin protein produced by our immune system when the body is infected by…
Milk Thistle skin
Milk Thistle: Find possible cures for fatal diseases in these purple blooms Milk thistle is well-known for treating liver conditions. However, did you know that it comes with a plethora…
Turner syndrome and infertility
Infertility profile (women) The infertility profile tests in women are conducted to form a complete picture of the hormonal balance and…
shakeology woman
Meal replacement or protein drink? Learn all about Shakeology and its claims Shakeology from Beachbody claims to be the most suitable shake that can aid in weight loss, regulate blood…
Bronchoscopy procedure
Bronchoscopy Bronchoscopy is a procedure where in a scope is inserted into the lung pathway to observe any growth…
anoscopy
Anoscopy Anoscopy is an invasive diagnostic procedure where a small device known as anoscope will be inserted in the…
Tamarind: The top health benefits of this staple Asian ingredient Did you know this sweet and sour pulpy fruit does more than just add a tangy flavor to…
Keto diet healthy
Keto Diet: Did you know you could eat fats to burn fats? Keto diet - A wonder diet that lets you eat fats and lose weight too! Read on to…
Echocardiogram
Echocardiography – ECHO Echocardiography (commonly known as ECHO) is an imaging modality (similar to ultrasonography) used to visualize the interior of…
creatinine
Creatinine Test The level of creatinine in the blood is a significant indicator of the health of your kidneys. This…
top 10 deadliest diseases
What are the top 10 deadliest diseases and what is causing them? What are the largest killers of human lives across the globe? Which diseases are the most fatal ones?…
Anti-Inflammatory foods: 18 foods to a disease-free you Anti-inflammatory foods are the foods which are known to reduce the inflammation as well as the pain from…
Kava: Is it the healthy substitute for alcohol you have been waiting for? Native to the beautiful South Pacific islands, Kava is a famous beverage rooted in the local culture. It…
Jack in the box fast food
Jack In the Box : The perils of surging fast food culture in the USA Jack in the Box - How a culture of fast-food can clog your arteries, weaken your heart, fatten…
beta hcg test
Beta hCG Test A Beta hCG test measures the level of human gonadotropin hormones present in the blood that is primarliy…
GM Diet: The fastest way to lose weight or yet another hoax diet? General Motors started this trend of extreme dieting for 7 straight days to ensure its employees were able…
antiHEV IgM test
Anti hepatitis E virus (Anti HEV) IgM Test Anti HEV IgM test determines the level of the IgM antibodies in the blood, The disease is often…
General adaptation syndrome: Understanding stress, one step at a time The struggle of the body to produce hormones during a stressful situation is the main theme of general…
Dragon Fruit – Blessing from Nature’s Basket Dragon fruit is packed with nutrients but low on calories. It is the dream food that can help…
blood ketone test
Blood Ketone (D3HB) Test The Blood Ketone Test measures and monitors the levels of ketone in the blood which is usually performed…
Astaxanthin: Why experts believe it could be 550x more potent than vitamin E! What is astaxanthin and why is this new supplement on the block touted as the most powerful antioxidant…
eating disorder anorexia
Eating Disorders: Lifestyle choice or a psychological condition? Is eating disorder just a harmless bad habit? Or does it represent grim psychological disorders? Do you want…
hidden causes obesity
8 hidden causes of obesity you probably didn’t know! Did you know that around 2 billion people worldwide are either overweight or obese? Are you too a…
C-Reactive Protein Test A CRP or c-reactive protein blood test is an important diagnostic tool used to determine the risk of…
understanding addiction
Addiction explained: An obsession that could cost you your life Is addiction a behavioral disorder? Or is it a chronic disease? How does addiction cause chemical and structural…
chloride test
Chloride Test A chloride test of the blood checks the level of chloride in body, an important factor governing the…
kidney stones
Kidney stones Kidney stones are solid substances made up of crystals. They can be of various sizes. Treatment depend on…
tonometry
Tonometry Tonometry uses a device called tonometer to measure the pressure inside the eye. This pressure is depends upon…
Juice Plus: Can you really replace actual fruits with pills?  Juice Plus supplements intend to fill nutritional gaps present in our daily diet. But how successful have they…
stress depressed anxiety
Are you depressed or just stressed? Know when to see a doctor Why are some people more anxious than others? Is being depressed the same as feeling sad? Have you…
The Shepherd's diet
Facts about the Shepherd’s diet Kristina Wilds promoted Shepherd's diet, a Christian-based diet that highlights Jesus Christ's diet as mentioned in the Bible.
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
colposcopy
Colposcopy Colposcopy is a simple, quick and non- invasive diagnostic tool to look closely inside the vulva, vagina, and…
Graston technique: A faster way to accelerate your rehabilitation after injury Graston technique is designed in such a way that any pain related to the soft tissue can be…
Vitamin K2: 8 reasons why you need this bone-building & cancer-fighting nutrient Vitamin K2 is claimed to be essential for your bone health, for reducing the risk of cancer, and…

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