What is Cholesteatoma?

Cholesteatoma is an abnormal growth of skin cells in the middle ear, typically behind the eardrum. Untreated, this condition can lead to hearing loss, dizziness, and chronic ear infections. Cholesteatoma is caused by a combination of genetic factors and long-term ear infections. This condition might also be called cholesteatoma ear.

Signs & Symptoms

Cholesteatoma symptoms can vary from mild to severe.

Symptoms of cholesteatoma may include the following:

• Persistent ear drainage – An unpleasant-smelling discharge from the affected ear is often one of the first symptoms noticed.
• Hearing loss – Progressive hearing loss can occur after damage to the delicate structures of the middle ear.
• Ear pain – Pain may be intermittent or persistent and can be aggravated by pressure changes or infections.
• Dizziness or vertigo – As cholesteatoma grows, it may affect the balance structures in the ear, leading to episodes of dizziness or vertigo.
• Ear pressure – You might experience pressure in your ear.

Causes

Cholesteatomas can develop because of a birth defect or chronic ear infections.

The main cholesteatoma causes include:

• Congenital cholesteatoma - This type of cholesteatoma is present at birth and is caused by a developmental abnormality.
• Eustachian tube dysfunction - The Eustachian tube plays a crucial role in maintaining balance within the middle ear by regulating pressure. Dysfunction of this tube can cause negative pressure, leading to the formation of cholesteatoma. This is also known as primary acquired cholesteatoma.
• Chronic ear infections - Repeated ear infections and ruptured eardrums can lead to the formation of cholesteatoma, as the eardrum gets pulled inward, creating a pocket where skin cells can accumulate. This is sometimes called secondary cholesteatoma.

Risk Factors

Several genetic factors can increase the likelihood of developing cholesteatoma.

Cholesteatoma risk factors:

• Family history – A history of cholesteatoma in close family members can increase an individual's risk.
• Down syndrome – Individuals with Down syndrome may be more prone to Eustachian tube dysfunction and ear infections, increasing their risk of cholesteatoma.
• Cleft palate – A cleft palate can also lead to Eustachian tube dysfunction and a higher risk of cholesteatoma development.
• Chronic ear infections – If you experience repeated ear infections, you may be more likely to develop cholesteatoma.

Diagnosis

Diagnosis of cholesteatoma typically involves a thorough ear examination and various tests.

The main tests include:

• Otoscopy – Your doctor will examine your ear using an otoscope to visualize the eardrum and assess the presence of cholesteatoma.
• Audiometric Test – This test measures an individual's hearing ability and helps determine the extent of hearing loss.
• Tympanometric Test – By measuring the movement of the eardrum, this test can identify abnormalities in the middle ear.
• Imaging studies – Your doctor might recommend imaging tests such as Magnetic Resonance Imaging (MRI) or Computerized Tomography (CT) scans to understand the scope of the cholesteatoma and examine the possibility of any potential complications.

Treatment

Cholesteatoma treatment typically involves surgery, but medications may also be used to manage symptoms.

Surgical Treatment

Surgery is the primary treatment for cholesteatoma.

Cholesteatoma surgery can involve several procedures, including:

• Mastoidectomy – Removal of cholesteatoma and infected mastoid bone.
• Tympanoplasty – Repair of the eardrum and reconstruction of the middle ear bones, if necessary.
• Ossiculoplasty – Rare repair or replacement of the middle ear bones to restore hearing.

The surgical method is determined by the cholesteatoma's dimensions and position, in addition to the patient's general health and medical background. A second surgery may be needed to ensure complete removal of the cholesteatoma and to reconstruct the middle ear bones.

Non-Surgical Treatment

In some cases, medications can be used to manage cholesteatoma symptoms, particularly when surgery is not immediately feasible.

These may include:

• Antibiotics – To treat or prevent infections associated with cholesteatoma.
• Steroid ear drops – To reduce inflammation and alleviate pain or discomfort.
• Pain reliever – Over-the-counter pain medications may be used to manage ear pain.

However, it is important to note that medications alone cannot cure cholesteatoma, and surgical intervention is typically required to prevent complications and restore hearing.

Prevention

While it may not always be possible to prevent cholesteatoma, particularly congenital cases, there are steps that you can take to reduce the risk of developing the condition.

These include:

• Prompt treatment of ear infections – Seeking timely medical attention for ear infections and following the prescribed treatment can help prevent chronic ear infections that may lead to cholesteatoma.
• Regular ear checkups – Regular checkups, particularly for those with a history of ear infections or a family history of cholesteatoma, can help detect the condition early.
• Avoid inserting objects into your ear – Using cotton swabs or other objects to clean your ear can inadvertently damage the eardrum and increase the risk of cholesteatoma.
• Manage Eustachian tube dysfunction – Addressing underlying conditions that can lead to Eustachian tube dysfunction, such as allergies or acid reflux, can help maintain proper middle ear function and reduce the risk of cholesteatoma development.