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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Pumpkin Seeds: Why pumpkins are more than just for pies! Pumpkins have been long associated with Halloween carvings and delicious pies. But did you know that pumpkin seeds…
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…
green poop causes
Green poop : What are the reasons and how can you correct it Ever sneak a peek down the toilet only to shockingly find green poop? Why does our poop turn…
complement c4 test
Anemia Profile Anemia Profile test (Basic) is a blood screening test that measures the levels of important components of the…
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.
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…
aspartame or sugar
Aspartame – Hidden truths about this storm in a teacup Aspartame, the artificial sweetener, has gone under the scanner on several occasions for allegedly doing more harm than…
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…
Diabetes blood test
Diabetic Profile The diabetic profile is a set of tests used for testing and monitoring the various kinds of Diabetes…
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…
Love tea, hate tannins? Rooibos tea is just what you need The market is brimming with a multitude of herbal teas. But what makes rooibos tea (or red bush)…
Is bronchitis contagious? And how to prevent this infection? It is acute bronchitis that is contagious which means you can contract it from another person or you…
cytomegalovirus iGG
Cytomegalovirus (CMV)- IgG Test The cytomegalovirus IgG is the immunoglobulin protein produced by our immune system when the body is infected by…
woman with abdominal pain holding ovulation calendar
Ovulation – facts to know about ovulation Learn how and when ovulation occurs, demystify common misconceptions, identify symptoms, methods of detection and right period for…
phenytoin test
Phenytoin test Phenytoin is a drug that is administered mainly to epilepsy patients. The phenytoin blood test measures the level…
Tissue Transglutaminase Antibody (tTG) Test Transglutaminase is an enzyme present in our body and is involved in protein metabolism. A tTg test is…
Chlorella: Therapeutic powers of the billion-year-old algae now within your reach Chlorella - A billion year old nutrient-rich algae that can potentially ward off cancers and high cholesterol; the…
Okra: How can this nutrient-dense vegetable help you fight diabetes? Okra is a food which is rich in nutrients and minerals which are extremely essential for a healthy…
tonometry
Tonometry Tonometry uses a device called tonometer to measure the pressure inside the eye. This pressure is depends upon…
dhea adrenal
Androstenedione Test Androstenedione is produced by the adrenal gland, the test of the levels of Androstenedione helps in the evaluation…
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…
How can Kegels help you overcome weak pelvic muscles & incontinence? Kegel exercises are pelvic floor strengthening exercises that can help you overcome incontinence issues that rise out of…
rosacea-treatment--before-_-after
The best and safest ways to treat rosacea Rosacea is a skin disease that is characterized by reddish hives and rashes on the face. Read more…
about mediterranean diet
Why you should be adopting a Mediterranean style of diet today Ever wondered why the Mediterranean diet is so healthy? One simple solution to lowering risk of several deadliest…
CERULOPLASMIN- triple marker
Triple Marker Test A triple marker test is an important prenatal test that is performed to detect the presence of chromosomal…
working mom with kids
Practical Motherhood Tips for Working Women Check out these effective tips for working mothers to manage motherhood and work life. Raise your children easily…
kidney stones
Kidney stones Kidney stones are solid substances made up of crystals. They can be of various sizes. Treatment depend on…
Bubble Tea: Bubbling with nutrition or a hidden sugar mine? The tapioca pearls present in the tea looks like bubbles and hence the name bubble tea became popular.…
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…
BRAT Diet: What is the right way to follow this diarrhea-relieving diet? BRAT diet, a simple diet consisting of just bananas, rice, applesauce, and toast, can help you combat the…
Coffee Enema: Turn your favorite morning beverage into a powerful colon cleanser The wonders of coffee are not just limited to waking you up every morning. You can now use…

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