Cholesteatoma
What is it?
A cholesteatoma is a benign, cystlike tumor in the eardrum or middle ear. Most commonly, a cholesteatoma develops when the eustachian tube (the passage between the ear and nose) is blocked for a prolonged period. Gradually, the air trapped in the middle ear is absorbed by surrounding tissue, resulting in greater air pressure outside the eardrum than inside. This pressure imbalance pushes the weakest part of the eardrum inward, creating a pocket. Old skin cells normally shed by the eardrum collect into a ball inside this pocket and form a cyst. If the eardrum is perforated, a cyst may form directly in the middle ear.
A cholesteatoma has the capacity to destroy bone and nerve tissue that lie in its path of growth. Cholesteatomas also harbor infection. The most common problem associated with these tumors is permanent, mild-to-moderate hearing loss due to damage to the delicate bones in the middle ear. If left untreated, the cyst may also eventually begin to erode the eardrum, the facial nerve, the bones lining the ear canal, or even the skull. In such advanced cases, complications can include epidural abscess and meningitis, two types of potentially life-threatening infections of the tissues surrounding the brain.
What Causes It?
- Repeated middle ear infections resulting from blockage of the eustachian tube, creating the conditions conducive to the development of a cholesteatoma.
- A congenital defect may prevent the eustachian tube from opening as it normally should during infancy.
- Risk of cholesteatoma is higher among those with a childhood history of ear infections.
Prevention
- Judicious use of antibiotics and myringotomy tubes (placed in the eardrums) can help an otitis-prone child avoid the later development of cholesteatoma.
- If your child has frequent ear infections, he or she should not be subjected to second-hand cigarette smoke, which can lead to even more frequent ear infections.
- Ongoing followup is required for otitis-prone children.
Diagnosis
- Patient history and physical examination are necessary. Your doctor will examine your ear with an otoscope, a device that permits a clear view of the entire ear canal.
- If your doctor suspects a cholesteatoma, a thorough examination by an otolaryngologist (ear, nose, and throat specialist) will be required.
- MRI (magnetic resonance imaging) may be used to confirm the diagnosis.
How to Treat It
- Surgery is the sole cure for cholesteatoma, and is required to halt progression of the disorder. Cyst removal usually requires opening the middle ear and, possibly, the mastoid process (a honeycomb-like bone behind the ear). This is often performed on an outpatient basis. To minimize the risk of recurrence, great care must be taken during the procedure to remove all traces of the cholesteatoma.
- Hearing may decline with removal of a cholesteatoma, and in more advanced cases, several operations may be necessary to rebuild the bones of the ear. Additional operations may be required to remove cysts that have grown back.
- If the cyst extends to the mastoid process and cannot be cured by antibiotics, a mastoidectomy (removal of the mastoid process) may be necessary.
- A hearing aid may be prescribed if normal hearing cannot be restored.
When to Call a Doctor
- Call a doctor if you experience hearing loss or any of the symptoms of cholesteatoma.
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Copyright © 2008 Medletter Associates, LLC
Content excerpted from Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference.