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 Cholesteatoma?
- 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.
Symptoms of Cholesteatoma
- Pus or mucus leaking from the ear(discharge may have a foul odor)
- Hearing loss, ranging from mild to severe
- Headaches and earaches
- Weakness of facial muscles
- Pressure or numbness in the ear
- 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.
- Patient history and physical examination are performed. Your doctor will examine your ear with an otoscope, a device that permits a clear view of the entire ear canal.
- Hearing and balance tests are performed to detect hearing loss and measure the extent of damage caused by the cholesteatoma.
- 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.
- CT(computerized tomography) scan is performed when cholesteatoma is detected with MRI. CT is used for preoperative planning (reconstruction of ossicles if needed) and to exclude perforation of the bony tegmen.
- Electronystagmography and caloric stimulation may be used to test the function of the nerves related to hearing and detect nerve damage to the ear
How to Treat Cholesteatoma
- Initial treatment involves a careful cleaning of the ear, antibiotics and ear drops to control the infection, dry up the fluid in the ear and stop the ear drainage.
- 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.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media