Understanding Cholesteatoma: Causes, Symptoms, and Treatment Options -Dr Aparna Mahajan

A cholesteatoma is a growth of skin behind the eardrum. It develops when dead skin cells gather behind the eardrum to form a lump or cyst that may look like a pearl. Cholesteatomas can be born or acquired later in life.

Without treatment, cholesteatomas may become infected or grow large enough to damage your hearing and facial nerve.

A cholesteatoma is an abnormal collection of skin cells deep inside your ear.

They're rare, but if left untreated, they can damage the delicate structures inside the ear that are essential for hearing and balance.

A cholesteatoma can also lead to:

1. An ear infection: causing discharge from the ear

2. Hearing loss: this can be permanent

3. Vertigo: the sensation that you, or the world around you, is spinning

4. Tinnitus: hearing sounds coming from inside the body rather than from an outside source

5. Damage to your Facial Nerve: this can cause weakness in half of your face

In very rare cases, an infection can spread into the inner ear and brain, leading to a brain abscess or meningitis.

Symptoms and Causes

Symptoms vary depending on whether you’re born with a cholesteatoma (congenital cholesteatoma) or develop one over time (acquired cholesteatoma). Congenital cholesteatomas may not cause symptoms until they get larger. Your child’s paediatrician could find a congenital cholesteatoma in their ear while doing a physical examination. But both congenital and acquired forms of the condition may cause the following symptoms:

1. A smelly discharge that may look like pus flowing from your ear or your child’s ear.

2. Pressure or a feeling of fullness in your ear.

3. Dizziness.

4. Recurrent ear infections

Sometimes, the condition can cause hearing loss or tinnitus.

What is the main cause of a cholesteatoma?

One of the main causes is a retracted eardrum. This is when there’s an imbalance between the air inside and outside of your ear. This causes your middle ear to pull in your eardrum. When that happens, you may develop a cyst or pocket that fills up with skin cells and becomes a cholesteatoma.

Chronic ear infections (acute otitis media) or ruptured eardrums can also lead to cholesteatomas. Children are rarely born with this condition.

Diagnosis

How is a cholesteatoma diagnosed?

A healthcare provider will ask about your symptoms and medical history, including whether you have a history of ear infections. Your ear, nose, and throat specialist (otolaryngologist) will then examine your ears with an otoscope, a device that allows them to look at your eardrum.

They may do the following tests:

1. Computed tomography (CT) scan to see if the condition damages your ossicles (ear bones).

2. Hearing tests, including a tympanometry test.

Management and Treatment

What are the treatments for cholesteatoma?

Treatments depend on the cause and symptoms, but surgeries like mastoidectomy and tympanoplasty are the only ways to remove a cholesteatoma.

In addition to removing the cholesteatoma, the surgeon may be able to improve your hearing. There are several ways to do this.

For example, a tiny artificial hearing bone (prosthesis) can be inserted to bridge the gap between the eardrum and the cochlea (hearing organ). In some cases, reconstructing the hearing may not be possible, or a further operation may be needed.

The benefits of removing a cholesteatoma usually far outweigh the complications. However, as with any type of surgery, there's a small risk associated with having an anaesthetic and a very small chance of facial nerve damage resulting in weakness of the side of the face.

You may need to stay in the hospital overnight after the operation, and you should plan to take a week or so off work.

When you get home, you must keep the affected ear dry. After a week, you should be able to wash your hair, provided you do not get water inside the ear. To avoid this, you can plug the ear with Vaseline-coated cotton wool.

You may be advised to avoid flying, swimming, strenuous activities, or sports for a few weeks after surgery. Ask when it will be safe to return to your usual activities at your follow-up appointment.

Prevention

1. You can’t prevent congenital cholesteatomas, but there are things you can do to reduce your risk that you’ll develop one:

2. Protect your ears from chronic infections or activities that could rupture your eardrum.

3. Incorporate your Ear, nose, and throat checkups as a part of your yearly preventative health checkup.

Outlook / Prognosis

What can I expect if I have a cholesteatoma?

If you’re like most people, surgery to remove a cholesteatoma will take care of your symptoms. But cholesteatomas can come back. Your otolaryngologist may recommend that you have regular checkups. Checkups may include:

1. Ear exams and hearing tests to check for signs of new cholesteatoma.

2. Ear washing (debridement) to remove skin cells and other tissue build-up.

Sometimes, a second operation is needed after about a year to check for any skin cells left behind. However, MRI scans are now often used instead of surgery to check for this.

Disclaimer: The views expressed in this article are of the author and not of Medical Dialogues. The Editorial/Content team of Medical Dialogues has not contributed to the writing/editing/packaging of this article.