Cholesteatoma Treatment
Cholesteatoma
Cholesteatoma is a skin growth that occurs in an abnormal location – the middle ear behind the eardrum (tympanic membrane), generally meaning the eustachian tube is not working properly. The eustachian tube can become blocked by allergies, colds, or sinusitis. Cholesteatoma is usually due to repeated ear infection, or inflammation of the middle ear, which causes an ingrowth of the skin cells of the eardrum. Cholesteatomas often take the form of a cyst or pouch which sheds layers of old skin that builds up inside the ear. Over time, the Cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear.
Cholesteatoma Symptoms
- Initially the ear may drain, sometimes with a foul odor.
- As the Cholesteatoma pouch or sac enlarges, it can cause a full feeling or pressure in the ear resulting in ear pain, along with hearing loss.
- Dizziness or weakness of the facial muscles on one side of the face (affecting the facial muscles on the side of the infected ear) can also occur.
- Bone erosion can cause the infection to spread into the surrounding areas, including the inner ear and brain. If untreated, deafness, brain abscess, meningitis, facial paralysis, and rarely death can occur.
- Chronic otitis media can also lead to a cholesteatoma. Otitis media, also known as an ear infection, is an inflammation of the middle ear that occurs when fluid builds up behind the eardrum.
Diagnosing Cholesteatoma
Here are the primary methods for diagnosing cholesteatoma:
Physical Examination:
- Otoscopy: Using an otoscope to look into the ear canal and view the eardrum, an ENT specialist may see signs of cholesteatoma, such as a visible mass, retraction pockets, or perforation of the eardrum.
- Microscopy: An ENT might use a more detailed examination with a microscope to better view the middle ear structures and any buildup of keratin or infection that could suggest cholesteatoma.
Hearing Tests (Audiometry):
- A hearing test can reveal conductive hearing loss, which is common in patients with cholesteatoma. This test can also help assess the extent of any damage to the ossicles (the bones within the ear) or the overall impact on hearing.
Imaging Studies:
- CT Scan (Computed Tomography): A CT scan of the temporal bone can show the extent of cholesteatoma and any bone erosion or damage to nearby structures. This imaging method is particularly useful in planning surgery.
- MRI (Magnetic Resonance Imaging): An MRI can be useful for diagnosing complex or recurrent cholesteatoma cases, particularly for distinguishing cholesteatoma from other masses or post-surgical changes.
Endoscopic Examination:
- Endoscopy of the Ear Canal: Sometimes, an endoscope is used to get a closer view of the ear structures, particularly if the cholesteatoma is located in areas that are hard to visualize with an otoscope.
Clinical History and Symptoms:
- Collecting a detailed history of symptoms such as recurrent ear infections, drainage, hearing loss, tinnitus, dizziness, or facial nerve symptoms can help guide the diagnosis, as these are common symptoms associated with cholesteatoma.
Diffusion-Weighted MRI (DWI-MRI):
- In some cases, especially with recurrent cholesteatoma, a DWI-MRI is used because it can specifically highlight the presence of keratin debris characteristic of cholesteatoma, offering a clearer diagnosis in follow-up cases or cases where CT findings are inconclusive.
These diagnostic methods help ENT specialists determine the presence, size, and impact of cholesteatoma on surrounding structures, enabling them to plan effective treatment.
Cholesteatoma Treatment
Persisting earache, ear drainage, ear pressure, hearing loss, dizziness, or facial muscle weakness signals the need for an evaluation by an Otolaryngologist. An ENT doctor can confirm the presence of a Cholesteatoma.
- Initial treatment may consist of a careful cleaning of the ear, antibiotics, and ear drops.
- Therapy aims to stop drainage in the ear by controlling the ear infection.
- The extent of growth characteristics of a Cholesteatoma must also be evaluated.
- Large or complicated Cholesteatoma usually require surgical treatment to protect the patient from serious complications.
