Cholesteatoma

What Is Cholesteatoma?

A cholesteatoma is an abnormal skin-covered cyst that can develop behind the eardrum and grow to invade the middle ear and the mastoid, which is the part of the skull behind the ear. While developing a cholesteatoma is rare, when the condition goes untreated, it can damage the areas inside the ear essential for hearing and maintaining balance. When a cholesteatoma develops, it grows aggressively. Unfortunately, the cyst also retains bacteria, so it becomes infected quickly, and surgical removal is the best solution for resolving the infection. Cholesteatoma can erode the bone, leading to hearing loss as it destroys the small bones that carry sound in the middle ear. In addition to hearing loss, the spread of infection caused by cholesteatoma can cause:

• Bony abscesses
• Vertigo
• Tinnitus
• Facial nerve damage leading to facial paralysis
• Labyrinthitis — an ear infection that leads to dizziness and hearing loss

In rare circumstances, the cholesteatoma can spread an infection into the inner ear and brain, leading to meningitis or brain abscesses.

What Causes Cholesteatoma?

Both adults and children can develop cholesteatoma. However, patients are at a higher risk of developing it if they have recurring ear infections or experience a ruptured eardrum. Cholesteatomas are broken into three main types, depending on their cause.

Primary Acquired Cholesteatoma

Primary acquired cholesteatoma develops when an ear doesn’t drain well or can’t manage balance pressure using the eustachian tube. The poor drainage pulls the eardrum toward the middle ear, and abnormal cells collect. 

Secondary Acquired Cholesteatoma

Secondary acquired cholesteatoma happens when an eardrum ruptures or part of the eardrum collapses and creates a pocket where dead skin cells collect behind the eardrum and form a cyst. This form of cholesteatoma can also develop if the eardrum experiences damage from an injury, infection, or after ear surgery.

Congenital Cholesteatoma

Congenital cholesteatoma is a rare condition where skin cells become trapped in the middle ear before birth. 

Symptoms of Cholesteatoma

Typically, a cholesteatoma affects only one ear, and drainage is often the first symptom. The discharge can be watery and may come and go or trickle continuously. It’s often dark, foul-smelling, and thick and sticky like earwax. Other cholesteatoma symptoms include:

• Pain
• Dizziness
• Altered sense of smell and taste
• Pressure in the ears

In some patients, a gradual loss of hearing in the affected ear is another early cholesteatoma symptom. 

Cholesteatoma Treatment

Once diagnosed, surgery is the only treatment option to remove a cholesteatoma. In addition to surgery, patients with a concurrent infection may require antibiotics to clear the infection and ear drops to slow drainage. Most cholesteatoma treatment plans involve two surgical procedures: a mastoidectomy and a tympanoplasty. A mastoidectomy removes disease from the mastoid, which is the bone behind the ear.A tympanoplasty repairs the eardrum with grafted cartilage or fascia to permanently close holes in the eardrum. If the cholesteatoma has damaged the small bones in the ears and impaired the patient’s hearing, a surgeon will work to repair them with synthetic or natural bones and cartilage. Cholesteatoma surgery is a delicate procedure performed under a microscope. Because the infections are aggressive and tend to grow back if any disease is left behind, patients need regular follow-up appointments to make sure that there’s no regrowth. In some cases, a second operation is necessary. 

Get Tested Today

Patients experiencing hearing loss and watery, foul-smelling discharge should see a physician to determine whether a cholesteatoma is responsible. A general practitioner can look into your ear with an otoscope, but a buildup of pus in the ear can block their view. As a result, many physicians will treat patients for an ear infection first and then ask to schedule a follow-up appointment. Patients with cholesteatoma symptoms should see a professional audiologist for a more advanced evaluation. This evaluation may include:

• Hearing loss tests
• An audiogram to assess the eardrum, middle ear, and hearing
• A CT scan to see any damage to the ear bones
• An MRI to see if the cholesteatoma has spread

An untreated cholesteatoma can cause permanent hearing loss and balance issues. In extreme cases, untreated patients can develop brain abscesses and meningitis. If you experience ear infections or drainage that doesn’t resolve, seek the care of a professional audiologist like the skilled team at Happy Ears Hearing Center in Gilbert, Surprise, and Peoria, Arizona. The symptoms of cholesteatoma should not be ignored. If you’re concerned about your auditory health, schedule your appointment with Happy Ears Hearing Center today.