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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Ovulation – facts to know about ovulation Learn how and when ovulation occurs, demystify common misconceptions, identify symptoms, methods of detection and right period for…
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…
CLA: A breakthrough weight loss supplement with minimal side effects Tried every weight loss supplement in the market with no substantial gain? Why not try CLA supplements, derived…
Psyllium Husk: More than just an effective natural laxative Psyllium husk, or isabgol, is a popular natural laxative . But did you in addition to regulating bowels,…
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…
Tart Cherry: The healthiest excuse for taking that second serving of pie Tart cherry has been traditionally used in delectable desserts such as pies. Recent studies have revealed that its…
GERD heartburn
Heartburn: What are the exact symptoms and the best home remedies? There are easy home remedies for heartburn, which not only acts as a first aid when you experience…
amylase test
Amylase Test Amylase test is done by checking the level of this protein in the blood sample and also in…
fructosamine test
Fructosamine Test A fructosamine test measures blood sugar glucose content. Fructosamine level can indicate blood sugar level in past 2-3…
Rubella IgM test
Rubella IgM Test The Rubella IgM test is a blood test that is performed to diagnose the presence of the rubella…
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…
sodium blood test
Blood Sodium Test A blood sodium test measures the amount of sodium (an important electrolyte) in your body. It is also…
leptospira Igm test
Leptospira-IgM Test A Leptospira-IgM test is a blood test which is carried out to detect anti-Leptospira IgM antibody. Leptospirosis is…
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…
Hymenoplasty
Hymenoplasty Read on to find out all about hymenoplasty, the procedure, post-surgery care, the risks, and the benefits.
hidden benefits walking
9 benefits of walking we bet you didn’t know! Did you know walking can be the miracle pill for eternal youth? Everyone knows walking is good for…
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…
xylitol gum
Xylitol : Is this the right sugar substitute for you? Discovered during World War 2 owing to sugar shortage, xylitol has become a common name in pharamaceutical industry.…
gallbladder diet tomato
Gallbladder surgery :Tips on post-operative care and diet What to eat post a gallbladder surgery? What are the key things to avoid if you had a…
black seed oil benefits
Black Seed Oil: What secret benefits could it bestow on your health? Black seeds or nigella seeds are tiny packets of health brimming with amazing benefits. Find out why should…
How can berberine supplements help you live longer and healthier? Berberine is a turmeric look-alike herbal extract that is credited with numerous health benefits ranging from diabetes cure…
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…
Experts reveal the safest ways to perform an enema at home The idea of pushing some up your rectal area might make you queasy but an enema could actually…
Quinine: How gin and tonic came to be known as a potent health elixir The discovery of quinine-containing tree bark is sometimes considered the most serendipitous medical discovery of the 17th century.
Barium-enema
Barium Enema Barium enema is also known as colon x-ray. Here, the patient is asked to consume small amount of…
GGt test
GGT – Gamma-Glutamyl Transferase Test GGT or gammaglutamyl transferase test is a liver function test that is used to detect the extent of…
Bloodtestalbumin
Albumin Test Albumin test or blood serum test is a liver function test that measures the amount of the protein…
blood elements analysis
Blood Element Analysis Test A blood element analysis is a blood test performed to measure the level of toxic elements such as…
anoscopy
Anoscopy Anoscopy is an invasive diagnostic procedure where a small device known as anoscope will be inserted in the…
Diabetes blood test
Diabetic Profile The diabetic profile is a set of tests used for testing and monitoring the various kinds of Diabetes…
oral hygiene tips
6 shocking consequences of bad oral hygiene (and how to avoid them) Did you know bad breath is not just turning off, but also harms your body in ways you…
avocado benefits
Avocado: 15 reasons why this fruit should be a staple in your diet Did you know that the word avocado literally means "testicles". Don't get grossed out as this power-packed fruit…
Cayenne: The remarkable benefits of these red hot chili peppers These may make you rush for a glass of water, but cayenne pepper is actually a healthy additive…
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…
How seitan proved to be a blessing in disguise for vegans worldwide Can only meat-eaters enjoy delicious juicy steaks and burgers? With seitan, the best meat substitute available today,even vegans…
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…
Mood swings
The real reasons for your mood swings and how to overcome them Are you prone to heated moods frequently? Do you also feel bouts of depressive feeling creeping up on…
Urologist: When should you visit one and why? A urologist can treat not only genitourinary problems of both men and women but also can treat various…
glucose-tolerance
Oral Glucose Tolerance Test – GTT Glucose tolerance test (or Oral GTT) is used to detect the onset of diabetes or prediabetes conditions. It…
ASTtest-liver
AST- Aspartate Aminotransferase Test AST test is a blood test that is used to measure the level of a particular liver enzyme…
ANTIPHOSPHOLIPIDANTIBODY(APL)_IgG
Antiphospholipid (APL) antibody-IgG The Antiphospholipid Antibody testing is a blood test used to determine an autoimmune disorder called Antiphospholipid syndrome linked…
Strep throat pain
Anti-Streptolysin-O Test The ASO or Anti-Streptolysin-O is a blood test designed to check for the presence of streptococcus bacterial infection…
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
malarial antigen test
Malaria Antigen Test A malaria antigen test is a rapid diagnostic test (RDT) that can detect malarial antigens (proteins) in your…
iron deficiency profile
Iron Deficiency Profile An iron deficiency profile is a battery of blood tests which are performed in order to determine the…
Hepatitis A virus infected liver
Hepatitis A Virus (HAV) Total Blood test to look for IgM antibodies to know if you are infected with Hepatitis A virus (HAV),…
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…
sugar toxic health
Sugar: 7 new shocking truths revealed about the sweet poison Can drinking soda bring you closer to death? Is sugar slowly poisoning you and your family? You would…
L-theanine attention
L-Theanine: Better sleep, higher focus, and many other benefits Did you know that L-theanine found in green tea can make you sleep better and be focused at…
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…
Agave nectar: The bitter truth about this sweetener revealed Agave nectar is considered to be sweeter than the normal table sugar and even contains higher amounts of…
gout diet purines
Gout Diet : Get relief from painful joints by eating these foods Are you a victim of this painful condition? Are medications providing only short relief? Find a list of…
DHEA wrinkles
DHEA: Now get unbelievable age defiance with this wonder hormone! DHEA is known popularly as the age-defying hormone. This supplement is widely used to slow down aging and…
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…
Pescatarian Diet 101: What are the inherent health advantages of this diet? People opt to become a pescatarian in order to enrich their bodies with the essential health benefits that…
What is the right way to take a pregnancy test? A pregnancy test is undertaken to determine if you have conceived. A home pregnancy test is the most…
Inhale oxygen, exhale worries: The top breathing exercises and how to perform them Performing the breathing exercise is like becoming mindful of how you breathe.  Here is a list of breathing…
hemoglobin variant analysis
Hemoglobin Variant Analysis Hemoglobin variant analysis is a blood test that is used to detect the presence of hemoglobin variants which…
cystatin C
Cystatin C Test Cystatin C is a specific single-chain protein that is found in body fluids and is a biomarker for…
piles fissure fistula
Allopathy vs homeopathy vs ayurveda treatment for piles, fissures, and fistula Read to know the best form of treatment among allopathy, homeopathy,or ayurveda for piles, fissures, and fistula
liver detox facts
7 liver detox facts and why ignoring these could kill you! Are you taking care of this organ that handles over 500 different vital functions in your body? Your…

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