Cholesteatoma, in its simplest definition, is skin in the wrong place. Skin is a normal part of the ear canal
and the outside part of the ear drum (tympanic membrane). When this skin grows
behind the ear drum or it grows into the bone behind the ear (mastoid bone), it
is called a cholesteatoma. This skin grows at a much faster rate than
regular skin and destroys the structures around it.
The treatment of a cholesteatoma is its removal by surgery. Close follow-up is
necessary to monitor for recurrence.
You may reference the
Anatomy of the Ear page for better
understanding of the anatomy.
Cholesteatomas most commonly present with hearing loss and
drainage from the ear. In advanced stages, facial paralysis or dizziness
(vertigo) can be a presenting sign.
There are 3 causes of
cholesteatoma that develops due to a retraction in the ear drum. When ear
present for a long time, the ear drum can slowly
get retracted (suctioned into the middle ear). Over time, the skin from the
outside grows into the space behind the ear drum and into the mastoid bone.
The cause of this retraction is a dysfunction in the eustachian tube (which
allows air to get from the back of the nose to the space behind the ear drum).
2. A cholesteatoma (skin) can grow into the space behind the ear
drum through a perforation in the ear drum.
3. A cholesteatoma can be present
since birth (congenital). This means that some skin existed behind the ear drum
How is a
Generally after a complete history
and physical exam, some tests need to be performed to diagnose and plan for the
treatment of cholesteatomas. A test of the hearing (audiogram and tympanogram)
and CT scan (special x-ray) of the temporal bone (ear bone) is necessary for
diagnosis and planning of treatment.
As the cholesteatoma grows, it destroys the bone around it. The
structures that can be invaded by the cholesteatoma include the little bones of
the ear (ossicles), which causes hearing loss, inner ear (which would cause
complete deafness and dizziness), the facial nerve (which would cause facial
paralysis), or invade the bone covering the brain and cause meningitis. If left
untreated, these complications will occur with time.
Initial treatment with antibiotic drops help in settling the
infection that causes the drainage. However, cholesteatomas can only
definitively be treated by removal using surgery. This generally requires an
incision inside the ear canal or in the back of the ear to get access to the
area of the cholesteatoma. Commonly, a second surgery is required after 6 to 12
months to ensure that the cholesteatoma has not recurred and for reconstruction
of hearing. Due to the presence of infection at the first surgery, hearing
reconstruction is generally performed at the second surgery.
in the Treatment of Cholesteatomas
The use of Otoendoscopy (small angled cameras) has been shown to
significantly reduce the chance of recurrence after surgery for cholesteatomas.
The chance of recurrence of cholesteatomas was reduced from nearly 50% to 5%. In
a study to be published by Dr. Djalilian and his colleagues, it was found that
using otoendoscopy will reduce the need for more radical surgery. Areas that are
around corners that are usually not visible with a microscope can be visualized
and cholesteatomas can be removed from those locations. At UC Irvine,
otoendoscopy (in addition to a microscope) is used routinely in the removal of cholesteatomas for a less invasive
To Make an
Appointment with Dr. Djalilian, Please Call
714-456-7017 or click
here to request an appointment via the
to UC Irvine Neurotology Division Page