What is Cholesteatoma?

Cholesteatoma is an abnormal growth of skin in the middle ear space or in the mastoid bone behind the ear. The growth

is classified as benign (non-cancerous).

What causes cholesteatoma?

Cholesteatomas can be present at birth (congenital) or form later in life (acquired).

Congenital Cholesteatoma

Congenital cholesteatomas are present at birth, either in the middle ear space or the mastoid

bone located in the skull behind the ear. There is no known cause of congenital cholesteatoma. It

is a developmental abnormality.

Acquired Cholesteatoma

• Cholesteatomas can form after repeated eustachian tube dysfunction (ETD) or ear infections.

• ETD causes negative pressure to build within the middle ear space and the eardrum is pulled inward.

• This inward pulling of the eardrum forms a pocket or perforation in the eardrum.

• This pocket or perforation fills with dead skin cells which builds up in the middle ear space.

Formation of acquired cholesteatoma

A cholesteatoma can continue to increase in size and affect the bones of the middle ear.

Symptoms of cholesteatoma

• Hearing loss in the affected ear• Discharge from the ear with or without an odor• Tinnitus in the affected ear• Dizziness and/or imbalance• Fullness or pressure in the ear• Facial weakness or paralysis

The most common symptoms of cholesteatoma include hearing loss and drainage from the ear. In severe cases where

the cholesteatoma is affecting surrounding structures, dizziness or facial weakness can occur.

Cholesteatoma hearing loss

• A cholesteatoma can cause a conductive hearing loss.

• The severity of the hearing loss will depend on the size of the cholesteatoma and whether it is affecting the bones of the middle ear (ossicles).

How is cholesteatoma diagnosed?Physical examination of the ear with an

otoscope. The dead skin tissue can sometimes be seen through the eardrum.

A CT Scan and Audiology evaluation may also be necessary to determine the size and extent

of damage of the cholesteatoma.

How is cholesteatoma treated?

• Initial treatment involves a thorough cleaning of the ear, antibiotics and ear drops to treat any infection.

• Surgery is necessary to remove the cholesteatoma from the middle ear or mastoid bone and preserve hearing.

Surgical procedures for cholesteatoma

• Tympanoplasty: surgery used to remove the cholesteatoma from behind the eardrum and repair the eardrum perforation by placing a “patch” over the hole.

• Mastoidectomy: surgery to remove the cholesteatoma from the mastoid bone.

• Tympanomastoidectomy: surgery that involves both the eardrum/middle ear space and the mastoid space.

• Ossiculoplasty: repair or reconstruction of the 3 bones of the middle ear (ossicles) that can be damaged by a cholesteatoma.

Can cholesteatoma cause lasting problems?

• If left untreated, cholesteatomas can become large and infected. It can spread to the inner ear and brain. This can lead to permanent hearing loss, dizziness, facial paralysis, brain abscess, or meningitis.

• Surgery is most often successful at removing a cholesteatoma, but additional surgery may be necessary if the cholesteatoma returns.

Resources:

https://www.marshfieldclinic.org/specialties/ent/ent-cholesteatoma

https://www.entnet.org/content/cholesteatoma

http://www.nlm.nih.gov/medlineplus/ency/article/001050.htm