Table of ContentsView AllTable of ContentsCausesIn ChildrenSymptomsComplicationsDiagnosisTreatmentPreventionOutlook
Table of ContentsView All
View All
Table of Contents
Causes
In Children
Symptoms
Complications
Diagnosis
Treatment
Prevention
Outlook
Cholesteatomais an abnormal skin growth within the middle ear.This serious ear condition can be present at birth or develop later in life, often as a result of multiple ear infections.
While cholesteatomas are noncancerous (benign), they can eat away at and damage the delicate bones within the middle ear and cause permanent hearing loss. Left untreated, another potential, albeit rare, complication of a cholesteatoma is an infection that can spread through the ear to the brain.
This article will review cholesteatomas' causes, symptoms, diagnosis, and treatment. It will also explore how this condition can be prevented and its generalprognosis(outcome).
Jacob Wackerhausen / Getty Images
What Is the Middle Ear?Themiddle earis an air-filled space between the eardrum (tympanic membrane) and the inner ear, a fluid-filled structure that transmits sound and balance signals to the brain.
What Is the Middle Ear?
Themiddle earis an air-filled space between the eardrum (tympanic membrane) and the inner ear, a fluid-filled structure that transmits sound and balance signals to the brain.
What Causes a Cholesteatoma?
The precise cause of a cholesteatoma is not fully known.
Experts suspect thatacquired cholesteatomasmost commonly occur as a result of a blockedeustachian tube.
Eustachian tubes link the middle ear to the sinuses. They help drain fluid from the middle ear and balance the pressure on either side of the eardrum.
Eustachian tubes can become blocked if:
With a blocked eustachian tube, the eardrum may retract or be sucked towards the inside of the ear.
Inflammation behind the eardrum can then trigger skin cells to grow rapidly. These cells eventually mature and die, shedding themselves withkeratin(a protein that helps form the outer skin layer) into a mass, enlarging over time to form a cholesteatoma.
Anacquired cholesteatomacan also form if there is inflammation within the outer lining of the eardrum and the eardrum has a hole or tear (perforation).
In such cases, rapidly growing cells may travel through the eardrum, embedding themselves within the middle ear.
Rarely, cholesteatomas are congenital, meaning they are present at birth.Congenital cholesteatomasarise from tissue that becomes trapped within the middle ear during development.
Cholesteatoma in Children
Cholesteatoma is a rare condition, and its symptoms and treatment are similar in children and adults.
Cholesteatoma is slightly more common in adults than children, affecting around 3 out of 100,000 children and 9 out of 100,000 adults.
Conversely, the recurrence rate of cholesteatoma (when the growth returns after being surgically removed) is higher in children than in adults.
What Are the Symptoms of a Cholesteatoma?
If cholesteatoma symptoms are present, they include:
Hearing loss from a cholesteatoma is generally attributed to the wearing away and eventual destruction of the middle ear’s tiny, fragile bones calledossicles.
What Are the Potential Complications?
As the cholesteatoma grows and spreads into the inner ear, symptoms reflecting damage or inflammation of the inner ear structures can develop.
These inner ear symptoms include:
Since cholesteatoma retains bacteria, it can spread and infect the mastoid bone (mastoiditis). The mastoid bone is honeycombed-shaped and behind the ear. It is part of thetemporal bone, located at the sides/base of the skull.
Potentially life-threatening, although rare, infections can then travel into the brain via the temporal bone.
These infections include:
Other severe complications of a cholesteatoma include:
How Is a Cholesteatoma Diagnosed?
A person with suspected cholesteatoma should be urgently referred to anotolaryngologist, also known as an ear, nose, and throat (ENT) specialist, for a more thorough evaluation.
If worrisome symptoms (e.g., vertigo or headache) are present, a person should go to the emergency room.
Next, a high-resolutioncomputed tomography (CT) scanof the temporal bone is performed to assess the extent of the cholesteatoma.Magnetic resonance imaging(MRI) may also be performed if complications are suspected.
After a cholesteatoma is visualized, a person will undergo anaudiogramtoassess hearing loss, including its type and severity.
How Is a Cholesteatoma Treated?
The treatment of a cholesteatoma is surgical removal undergeneral anesthesia. The exact operation performed depends on the size and extent of the growth but generally involvesmastoidectomyandtympanoplasty:
Ossicular reconstruction—repair of the small bones in the middle ear—may also be performed.
Ways to Prevent Cholesteatomas
Long-Term Outlook for People With a Cholesteatoma
For most people, surgical removal of the cholesteatoma is successful.
However, cholesteatomas can grow back (recur). Another surgery may or may not be needed, depending on the size and other factors.
Research suggests that cholesteatoma recurrence rates are as high as 30% in adults and 70% in children.The type of cholesteatoma—acquired vs. congenital—does not appear to affect the likelihood of recurrence.
Due to the risk of recurrence, people must follow closely with their ENT after surgery.
Lastly, while surgical removal of a cholesteatoma is necessary, it does not always improve hearing. Sometimes, a second surgery is needed to help restore hearing loss.
Summary
Cholesteatoma is an expanding skin growth within the middle ear that can develop in children or adults. Although rare, it can be present at birth.
Symptoms of a cholesteatoma include hearing loss and persistent or recurrent ear drainage. Left untreated, complications such as dizziness, loss of balance, and, rarely, brain infections or clots can develop.
An otolaryngologist (ENT specialist) diagnoses cholesteatomas using an otoscope. Imaging tests are performed to evaluate the extent of the skin growth and for complications.
Treatment involves surgical removal. Sometimes, a second surgery is needed if the cholesteatoma recurs or to help restore hearing loss.
If you have a cholesteatoma or have had one removed, speak with an ENT specialist. Early treatment and close follow-up are key to managing this serious ear condition.
14 Sources
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