Cholesteatoma

A cholesteatoma is a cyst found within the middle ear and mastoid bone, behind the eardrum. In most cases, cholesteatoma is a result of chronic ear infections, multiple sets of tympanostomy tubes, or a history of eardrum perforation. Occasionally, cholesteatomas can be congenital and occur in patients without any history of ear problems. A cholesteatoma can be dangerous and should be treated. As it grows, it can lead to hearing loss (either temporary or permanent), dizziness, pain and drainage from the ear. In severe cases, it can lead to erosion of the bone overlying the brain and subsequently cause meningitis.

Cholesteatoma symptoms typically begin with recurrent or persistent ear drainage that may smell foul. As the cyst’s pouch grows, it can cause a full feeling in the ear, along with hearing loss. Dizziness, or muscle weakness on the affected side of the face may also occur. Any, or all, of these symptoms warrant medical evaluation.

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Our otologists can usually confirm cholesteatoma diagnosis without additional testing. Occasionally, your surgeon may request a CT scan and/or an MRI to evaluate the cyst and help with surgical planning. Initial treatment may be conservative and will consist of a careful ear cleaning, antibiotics and ear drops. Initial treatment aims to eliminate the acute infection. Sometimes, if the infection resolves, the cholesteatoma can be managed with frequent evaluations and in-office ear cleaning.

Larger or more complicated cholesteatomas (like those causing hearing loss or those unresponsive to medical treatment) usually require surgical intervention. Surgical removal of the cholesteatoma and infected area is performed under general anesthesia on an outpatient basis. The first goal of surgery is to achieve an infection-free, dry ear. The second goal is hearing preservation or restoration. In aggressive disease, destruction of the hearing bones may occur. But hearing loss may not be noted until after the surgery since the cholesteatoma sac itself can actually assist in the conduction of sound through the middle ear. Only with removal of the disease will hearing loss be noticeable. In most cases, a second surgery 6-9 months later will be required to ensure complete elimination of the disease, as well as to perform hearing reconstruction if possible.

Most cholesteatoma patients will require one week or less away from work or school, but restrictions on physical activity may be up to 4-6 weeks.