Cholesteatoma

Overview

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.

Presenting Symptoms

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.

Causes

There are 3 causes of cholesteatoma

1. A cholesteatoma that develops due to a retraction in the ear drum. When ear disease is  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). See anatomy

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 from birth.

How is a Diagnosis Made?

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.

Complications

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.

Treatment

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. 

New Innovations 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 approach. 

To Make an Appointment with Dr. Djalilian, Please Call 714-456-7017 or click here to request an appointment via the web.

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