Cholesteatoma
Cholesteatoma is a condition in which an abnormal, noncancerous skin growth occurs in the middle ear, behind the eardrum. It continues to grow in size, and therefore if left untreated, it might lead to hearing loss. The condition may be a birth defect, although it is also generally caused by repeated middle ear infections.
This condition also often develops as a cyst, or sac, that sheds layers of its old skin. When these dead skin cells accumulate, the growth can increase in size and destroy the delicate bones of the middle ear. This might affect the hearing, balance as well as function of the facial muscles.
Symptoms
Generally, a cholesteatoma causes symptoms only in a single ear. The signs can include any of the following:
- Constant sound inside your ear
- Ear infection
- Pain in the ear
- Dizziness or vertigo
- A feeling of fullness in one ear
- A fluid that smells bad and leaks from the ears
- Weakness in half of the face
- Trouble hearing in one ear
If you’ve suffered from a cholesteatoma for a long time and haven’t treated it, it might grow into other areas of your ear, like the part used for balance. It may even turn into an infection in your inner ear or even in the brain. This can lead to a pus-filled swelling in your brain or meningitis. Both are rare.
Causes
A cholesteatoma might occur due to multiple reasons:
- Cholesteatomas are generally caused by repeated middle-ear infections. If left untreated, infections from a long-established cholesteatoma might spread to the inner ear and the brain.
- Perforation of the eardrum, which can be caused by a trauma or an infection, might provide an opening for the skin of the outer surface of the eardrum, to grow through.
- Chronic ear infections, sinus infections, allergies, and colds might affect the Eustachian tube i.e. the tube connecting the back of your nose to your middle ear. This can keep it from equalizing air pressure on either side of your eardrum. This might cause a partial vacuum in your middle ear that may pull a section of your eardrum into it. This eardrum tissue can thus, turn into a cholesteatoma.
- Although rare, some people can also be born with a small remnant of skin that is trapped in the middle ear.
- As it grows larger, the cholesteatoma gets filled with sloughed-off skin cells, fluids, along with other wastes. This creates an ideal environment for infection. The growing cyst also increases pressure in your ear, which may lead to hearing loss. If it grows very large, it can destroy the surrounding bone, thus damaging the eardrum, and the bones inside your ear and near your brain, as well as your facial nerves. At this stage, it is possible that permanent hearing loss may occur.
Diagnosis
Your doctor is going to need to look inside your ear with an otoscope. This instrument has a magnifying glass with a light on it. This also tests how well you are able to hear sounds to check if your cholesteatoma has affected your hearing.
If your doctor thinks that you are having a cholesteatoma, then they are going to refer you to an ear, nose, or throat specialist. In order to look more closely at your cholesteatoma, your doctor will likely recommend the following tests:
CT Scan or Computerized Tomography
This is a series of X-ray images that are able to show a detailed image of the bones, soft tissues as well as blood vessels inside your ears. This test can let your doctor known if your cholesteatoma has grown into the bones of your ear, which may mess with your hearing and balance. Your doctor might want to do this scan if surgery is a better option for you.
MRI or Magnetic Resonance Imaging
If a CT scan is able to show your doctor something that requires a closer look, then an MRI is used if your doctor suspects an infection has spread to the brain.
Treatment
Surgery
Although there is no medicine that can make cholesteatoma go away, it is possible to remove it surgically. Surgery generally doesn’t require more than 2 to 3 hours, and you won’t need to stay in a hospital.
You’ll also receive medicine to make you sleep, and the removal can be done in either of two ways:
Mastoidectomy
Tympanoplasty
This can fix damage to your eardrum or the tympanic membrane. Your surgeon is going to use cartilage or muscle from another part of your ear for filling any holes in your eardrum.
Surgery also often helps with your hearing loss partially.
Cholesteatomas can sometimes be aggressive. They may return if not fully removed. It is therefore very important to see your doctor for regular follow-up visits.
Complications
If left untreated, a cholesteatoma is going to grow larger and cause complications. Complications can range from mild to severe.
The dead skin cells accumulating in the ear help in providing an ideal environment for bacteria as well as fungi to thrive. This means that the cyst can become infected, and thus cause inflammation as well as continual ear drainage.
Over time, this condition may also destroy the surrounding bone. It might cause damage to the eardrum, the bones inside the ear, the bones near the brain, as well as the nerves of the face. Permanent hearing loss might also occur if the bones within the ear are broken.
This cyst might even spread into the face if it continues to grow and this can lead to facial weakness.
Some other potential complications include:
- Swelling of the inner ear
- Paralysis of the facial muscles
- Chronic infection of the ear·
- Meningitis, which is a life-threatening brain infection
- Brain abscesses, or pus collecting in the brain