Insight into ear growths
- What causes a cholesteatoma?
- How is cholesteatoma treated?
- Symptoms and dangers
- and more…
An abnormal skin growth in the middle ear behind the eardrum is called cholesteatoma. Repeated infections and/or a tear or pulling inward of the eardrum can allow skin into the middle ear. Cholesteatomas often develop as cysts or pouches that shed layers of old skin, which build up inside the middle ear. Over time, they can increase in size and destroy the surrounding delicate bones of the middle ear leading to hearing loss that surgery can often improve. Permanent hearing loss, dizziness, and facial muscle paralysis are rare but can result from continued growth.
What are the causes?
A cholesteatoma usually occurs because of poor eustachian tube function as well as infection in the middle ear. The eustachian tube conveys air from the back of the nose into the middle ear to equalize ear pressure (“clear the ears”). When the eustachian tubes work poorly, perhaps due to allergy, a cold, or sinusitis, the air in the middle ear is absorbed by the body, creating a partial vacuum in the ear. The vacuum pressure sucks in a pouch or sac by stretching the eardrum, especially areas weakened by previous infections. This can develop into a sac and become a cholesteatoma. A rare congenital form of cholesteatoma (one present at birth) can occur in the middle ear and elsewhere, such as in the nearby skull bones. However, the type of cholesteatoma associated with ear infections is most common.
How is cholesteatoma treated?
An examination by an otolaryngologist-head and neck surgeon can confirm the presence of a cholesteatoma. Initial treatment may consist of careful cleaning of the ear, antibiotics, and ear drops. Therapy aims to stop drainage in the ear by controlling the infection. The growth traits of a cholesteatoma must also be evaluated. A large or complicated cholesteatoma usually requires surgical treatment to protect the patient from serious complications. Hearing and balance tests, and CT scans (3-D x-rays) of the mastoid may be necessary. These tests are performed to determine the hearing level in the ear and the extent of destruction the cholesteatoma has caused.
Surgery is performed under general anesthesia in most cases. The primary purpose of surgery is to remove the cholesteatoma to eliminate the infection and create a dry ear. A second surgery is sometimes necessary both to ensure that the cholesteatoma is gone as well as to attempt the reconstruction of the damaged middle ear bones in an effort to improve hearing. In cases of severe ear destruction, reconstruction may not be possible. Facial nerve repair or procedures to control dizziness are rarely required. Reconstruction of the middle ear is not always possible in one operation; therefore, another operation may be performed six to 12 months later. This operation will attempt to restore hearing and, at the same time, allow the surgeon to inspect the middle ear space and mastoid for residual cholesteatoma.
Surgery is commonly performed in an out-patient setting. For some patients, an overnight stay is necessary. In rare cases of serious infection, prolonged hospitalization for antibiotic treatment may be necessary. Time off from work is typically one to two weeks. After surgery, follow-up office visits are necessary to evaluate results and to check for recurrence. In cases requiring the creation of an open mastoidectomy cavity, office visits every few months are needed to clean out the mastoid cavity and prevent new infections. Some patients will need lifelong periodic ear examinations.
Symptoms and dangers
Initially, the ear may drain fluid with a foul odor. As the cholesteatoma pouch or sac enlarges, it can cause a feeling of fullness or pressure in the ear, along with hearing loss. An ache behind or in the ear, especially at night, may cause significant discomfort. Dizziness or muscle weakness on one side of the face (the side of the infected ear) can also occur. Any or all of these symptoms are good reasons to seek medical evaluation.
Cholesteatoma is a serious but treatable ear condition, which can be diagnosed only by medical examination. Bone erosion can cause the infection to spread into the surrounding areas, including the inner ear and brain. If untreated, deafness, brain abscess, meningitis, and, rarely, death can occur.
Frequently Asked Questions
A cholesteatoma is an abnormal skin growth that occurs in the middle ear behind the eardrum. It typically develops as cysts or pouches that shed layers of old skin, which accumulate inside the middle ear, potentially damaging delicate surrounding bones.
Cholesteatomas often result from poor eustachian tube function and repeated middle ear infections. When the eustachian tubes do not work properly, negative pressure is created in the ear, causing the eardrum to retract and form a sac that can turn into a cholesteatoma. Allergies, colds, sinus infections, or previous ear infections can contribute to its development.
Symptoms include foul-smelling fluid drainage from the ear, a feeling of fullness or pressure, hearing loss, ear pain especially at night, dizziness, and facial muscle weakness on the affected side. These symptoms warrant prompt medical evaluation.
Diagnosis is made by an otolaryngologist through ear examination. Hearing and balance tests, as well as CT scans of the mastoid bone, may be conducted to assess the extent of the cholesteatoma and related damage.
Initial treatment involves cleaning, antibiotics, and ear drops to control infection and drainage. Surgical removal is often necessary for larger or complicated cholesteatomas to eliminate the growth and prevent serious complications. Surgery may be followed by additional procedures to reconstruct damaged middle ear bones and restore hearing.
If untreated, a cholesteatoma can grow and destroy middle ear bones, leading to permanent hearing loss, dizziness, facial paralysis, and can spread infection to the inner ear and brain, causing serious conditions like brain abscess or meningitis, which are life-threatening.
Most surgeries are outpatient with some patients requiring an overnight stay. Recovery typically involves one to two weeks off work, follow-up visits to monitor healing and check for recurrence, and, if an open mastoid cavity is created, periodic cleaning visits to prevent reinfection. Some patients require lifelong ear exams.
Surgery aims to remove the cholesteatoma and stop infection. Hearing improvement depends on the extent of ear damage. Reconstruction of the middle ear bones may restore hearing, but in severe cases, full restoration is not always possible, and multiple surgeries may be needed.
