Cholesteatoma

Cholesteatoma is a skin growth in the middle ear behind the eardrum. There are three causes:

• Repeated middle ear infections and poor eustachian tube drainage: Usually when middle ear infections become chronic, the eardrum will be sucked inward due to a vacuum that is formed in the middle ear as the fluid becomes thicker. This suction, which stretches the eardrum inward, can create a pouch or sac of skin. Eventually a skin-lined sac forms which continues to grow and cause infection and bony destruction.
  
  
• A perforation of the eardrum that occurs because of a chronic infection or direct trauma: The skin over the outer surface of the eardrum can grow through the perforation and into the middle ear.
  
  
• Cholesteatoma present at birth: This is due to skin being trapped during growth of the fetus, however, and is not very common.

If you have a Cholesteatoma, you may notice drainage from your ear that has a bad smell. This is because when the dead cells accumulate in the middle ear there is no way for the body to get rid of them. As this ball of dead cells accumulates, it produces enzymes that destroy the bone.

You may also feel a lot of pressure in your ear, often noted as a sense of "fullness." You may also have some hearing loss. Aching in or behind the ear, along with dizziness, or partial facial weaknesses are also signs of Cholesteatoma.

If you have these symptoms, do not ignore them. If left untreated, Cholesteatoma can lead to deafness, brain abscess, meningitis, and, in very rare cases, death.

Diagnosis

To diagnose Cholesteatoma, Dr. Alexander typically has an audiogram done and a CT scan of the temporal bone. An audiogram is a hearing test conducted in a sound proof room by an experienced audiologist. The CT scan focuses on very thin sections of the structures within the temporal bone, because a regular CT would not show enough detail.

Treatment

Initially, you will be treated with antibiotics and ear drops to control the infection. If the Cholesteatoma is small, the infection can be controlled, and hearing remains at an acceptable level, it is possible to clean it out in the office under microscopic examination at periodic intervals. In other circumstances, surgery is necessary to prevent the progression of infection and destruction the bone.

Since the spread of infection is major concern, the primary goal of surgery for cholesteatoma is to treat it. The secondary goal is to restore hearing.

The procedure can last anywhere from one hour to three hours depending on the size of the cholesteatoma and extent of infection.

The procedure is performed under general anesthesia using a high powered microscope. If the cholesteatoma is small and can be removed entirely in one piece, the eardrum and the ossicles are reconstructed all in one operation. If it is larger and cannot be removed in one piece then a second and sometimes third procedure may be necessary. This is important because any pieces left in the ear may begin to regrow.

If the cholesteatoma is extensive and is growing into the inner ear or facial nerve, it may not be possible to remove the entire cholesteatoma, and a radical mastoidectomy has to be performed. If the damage is severe, reconstruction may not be possible.

Surgery can be performed either through the ear canal or in combination with an incision behind the ear.