Conditions: Cholesteatoma
Cholesteatoma is a serious condition involving the ear which, if untreated, can progress to cause hearing loss, ear infection, vertigo, or brain infection.
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What is cholesteatoma?
Cholesteatoma is a dangerous condition of the ear whereby skin cells collect behind the eardrum, expand, and can eventually erode through surrounding structures. Normally, skin cells are shed from the skin continuously, similar to hairs falling off. Skin cells shed from the ear canal make their way out of the canal with the aid of ear wax. But when live skin cells abnormally migrate behind the eardrum (the middle ear and mastoid space), dead skin cells are continuously produced, but they cannot escape to the outside world. An accumulation of dead skin cells, called a cholesteatoma, tends to become larger and become infected. The ear often drains pus chronically through a hole in the eardrum. A cholesteatoma may erode through bone, including the bones conducting sound vibrational energy in to the middle ear (the ossicles), the bone surrounding the inner ear (cochlea and vestibular system), or the space containing the brain (the cranial vault). Erosion into these important structures can cause significant problems, including deafness in that ear, vertigo, and infection of and around the brain.
What causes cholesteatoma?
A minority cholesteatomas are present at birth due to abnormal middle ear development. More commonly, cholesteatomas are acquired as a consequence of long-standing changes in the eardrum from Eustachian tube dysfunction and/or middle ear infection.
Cholesteatoma and hearing loss
Because of the destruction of normal anatomy, a cholesteatoma is often associated with hearing loss, especially if it is large. A small cholesteatoma may not yet cause hearing loss and on occasion, when a cholesteatoma has eroded into the bones of the middle ear but is positioned such that the solid mass of cholesteatoma transmits sound waves in place of the eroded bones, hearing loss may not be present.
cholesteatoma and infection
Since the space behind the middle ear is not sterile, and since a cholesteatoma consists of dead skin cells, infection commonly sets in. This can make diagnosis of cholesteatoma somewhat difficult at first, since most ear infections are not the result of cholesteatoma. Many times, cholesteatoma is identified only after initial treatments for an ear infection fail or if these treatments reduce the amount of infection enough that a better visual exam can be obtained.
What problems can cholesteatoma cause?
When untreated, cholesteatomas progress in size and severity. When very small, the problem may be unnoticed. As it grows and becomes infected, it can cause hearing loss, chronic ear drainage, and destruction of bone within the ear, including the bone separating the ear from the brain. In severe cases, infection from cholesteatoma can spread around or within the brain and may be life-threatening.
How is cholesteatoma diagnosed?
Cholesteatoma may be diagnosed by physical examination (looking in the ear), but not all cholesteatomas are visible this way. Suspicion for cholestea is increased by seeing the presence of a beefy red type of tissue called granulation tissue near the tympanic membrane (eardrum), an ear that is chronically draining fluid, and when an individual has a history of cholesteatoma, even if treated previously. CT imaging of the temporal bone (ear and inner ear) may be utilized to assess for cholesteatoma.
How is cholesteatoma treated?
In almost all cases, cholesteatoma is treated by surgical removal. Reconstructing the structures damaged by the cholesteatoma, such as the eardrum, the bones of the middle ear or the barrier between the cranial vault and the mastoid, may also need to be performed, though this is often done in a separate setting when the surgeon is sure that all of the cholesteatoma has been removed.