Cholesteatoma

Cholesteatoma is an abnormal skin growth. 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.

Symptoms

Cholesteatomas are often present when there is hearing loss or drainage from one ear.

In its advanced stages, facial paralysis or dizziness can be a sign of trouble.

Causes and complications

• Eardrum perforation. When the eardrum becomes perforated, skin can grow through the hole into the space behind the ear drum.
• Congential defect. Sometimes skin behind the ear drum is present at birth.
• Ear drum retraction. The ear drum can pull back when ear disease is present for a long time. As the ear drum retracts, skin grows into the space.

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.

Diagnosis

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.

Treatment

Initial treatment is with antibiotic drops, which help settle the infection causing the drainage.

However, cholesteatomas can only definitively be treated by surgical removal. This generally requires an incision inside the ear canal or in the back of the ear.

A second surgery is often required six to twelve months later to ensure that the cholesteatoma has not recurred and for reconstruction of hearing.

Because there is usually an infection in the ear during the first surgery, hearing reconstruction is generally performed at the second surgery.

Otoendoscopy

The use of otoendoscopy (small angled cameras) has been shown to significantly reduce the recurrence of cholesteatomas, from nearly 50 percent to 5 percent.

In a study to be published by Dr. Hamid 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 seen with an otoendoscope and removed.

At UCI Health, otoendoscopy (in addition to a microscope) is used routinely in the removal of cholesteatomas for a less invasive approach.