What Is A Cholesteatoma?
A cholesteatoma is a skin growth that occurs in an abnormal location in the middle ear behind the eardrum. It is usually due to repeated infection, which causes an ingrowth of the skin of the eardrum. Cholesteatomas often take the form of a cyst or pouch that sheds layers of old skin that build up inside the ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear. Hearing loss, dizziness, and facial muscle paralysis are rare but can result from continued cholesteatoma growth.
Causes Of Cholesteatoma
A cholesteatoma usually occurs because of poor Eustachian Tube function as well as infection in the middle ear. The Eustachian Tube conveys air from the back of the nose into the middle ear to equalize ear pressure (“clear the ears”). When the Eustachian Tubes work poorly, perhaps due to allergy, a cold or sinusitis, the air in the middle ear is absorbed by the body, and a partial vacuum results in the ear. The vacuum pressure sucks in a pouch or sac by stretching the eardrum, especially areas weakened by previous infections. This sac often becomes a cholesteatoma. A rare congenital form of cholesteatoma (one present at birth) can occur in the middle ear and elsewhere, such as in the nearby skull bones. However, the type of cholesteatoma associated with ear infections is most common.
Initially, the ear may drain, sometimes with a foul odor. As the cholesteatoma pouch or sac enlarges, it can cause a full feeling or pressure in the ear, along with hearing loss. (An ache behind or in the ear, especially at night, may cause significant discomfort.) Dizziness or muscle weakness on one side of the face (the side of the infected ear) can also occur. Any, or all, of these symptoms, are good reasons to seek medical evaluation.
Is Cholesteatoma Dangerous?
Ear cholesteatomas can be dangerous and should never be ignored. Bone erosion can cause the infection to spread into the surrounding areas, including the inner ear and brain. If untreated, deafness, brain abscess, meningitis, and rarely death can occur.
What Patients Are Saying
Dr. Jeffrey Cutler is terrific. I have had chronic sinusitis for years. Dr. Cutler has mapped out strategies and procedures to mitigate the frequency of my sinusitis episodes. He is personable, relatable, and takes the time to question and completely understand your current situation. He uses diagnostic tools, your history & physical examination to estblish a differential diagnosis and then discusses treatment options with you NOT to you. He is top notch.
I have been dealing with extremely weird problems with my right ear for about two and a half months. After being ignored at my regular physicians office, I decided to see Dr. Schwartz ( Swartz) and I am so happy I did. The hearing test was thorough and I received the results immediately after which gave me relief. The assistant was so nice and made me feel like she was truly listening to me. I loved how she relayed everything to the doctor before he came in. Because of this, He gave me answers and set up a game plan immediately. I have never felt so taken care of! I truly felt important and heard. Thank you everyone in the office for being so amazing!
I recently had to find a new ENT after my employer changed my insurance. I have a complicated health history so it can be daunting to find a new provider that you trust. I was very pleased with Dr. Picerno – she was kind, patient and very thorough! I’m so happy to have found her! I also met with Amelia, an audiologist, and she was also awesome!
Treatments For Cholesteatoma
An examination by an otolaryngologist can confirm the presence of a cholesteatoma. Initial treatment may consist of a careful cleaning of the ear, antibiotics, and ear drops. Therapy aims to stop drainage in the ear by controlling the infection. The extent or growth characteristics of a cholesteatoma must also be evaluated.
Large or complicated cholesteatomas usually require surgical treatment to protect the patient from serious complications. Hearing and balance tests and CAT scans of the mastoid may be necessary. These tests are performed to determine the hearing level remaining in the ear and the extent of destruction the cholesteatoma has caused. Surgery is performed under general anesthesia in most cases. The primary purpose of the surgery is to remove the cholesteatoma and infection and achieve an infection-free, dry ear. Sometimes the surgery can be necessary urgently, as in the case of a bone erosion penetrating the skull base, near to the dura, or lining of the brain. Hearing preservation or restoration is the second goal of surgery. In cases of severe ear destruction, reconstruction may not be possible. Facial nerve repair or procedures to control dizziness are rarely required. Reconstruction of the middle ear is not always possible in one operation, and therefore, a second operation may be performed six to twelve months later. The second operation will attempt to restore hearing and, at the same time, inspect the middle ear space and mastoid for residual cholesteatoma.
Follow-up office visits after surgical treatment are necessary and important because cholesteatoma sometimes recurs. In cases where a large bony cavity has been created, office visits every few months are needed in order to clean out the cavity and prevent new infections. In some patients, there must be lifelong periodic ear examinations.
Cholesteatoma is a serious but treatable ear condition which can only be diagnosed by medical examination. Persisting earache, ear drainage, ear pressure, hearing loss, dizziness, or facial muscle weakness signals the need for evaluation by an otolaryngologist-head and neck surgeon.
AOO | ENT Specialist of the Rockies is a practice that has been serving the Denver area for over 40 years. This group of board-certified physicians has exceptional experience treating multi-generational families and meeting their needs in ENT services, sleep health, sinus and allergy treatment, hearing treatment, and facial plastic surgery. Our team includes ENT physicians, specialty-trained nurses, audiologists, and plastic surgeons. In addition to outstanding routine care, our team is available 24/7 for emergencies