Cholesteatoma

A cholesteatoma usually occurs because of poor eustachian tube function in combination with infection in the middle ear. When the eustachian tube is not working correctly, pressure within the middle ear can pull part of the eardrum the wrong way, creating a sac or cyst that fills with old skin cells. If the cyst gets bigger, some of the middle ear bones may break down, affecting hearing. Rarely, a congenital form of cholesteatoma (one present at birth) can occur in the middle ear and elsewhere, such as in the nearby skull bones.

Cholesteatoma is an abnormal growth of skin in the middle ear behind the eardrum. It can be congenital (present from birth), but it more commonly occurs as a complication of chronic ear infections. Individuals with this condition usually experience a painless discharge from the ear. Hearing loss, dizziness, and facial muscle paralysis are rare but can result from continued cholesteatoma growth. Treatment usually involves surgery to remove the growth.

It is not know how many people develop cholesteatomas, but it is a relatively common reason for ear surgery (approximately weekly in tertiary otologic practices or children's hospitals). The number of congenital cases is not known, but it is considered to be more rare than the non congenital form.

Cholesteatomas usually continue to grow if not removed. Surgery is typically successful, but occasional ear cleaning by a healthcare provider may be necessary. Additional surgery may be needed if the cholesteatoma comes back.

In rare cases, complications may arise. These include:

• A collection of pus and other material in the brain (brain abscess)
• Hearing loss in one ear
• Dizziness (vertigo)
• A breakdown of the facial nerves leading to facial paralysis
• Meningitis
• Persistent ear drainage
• Spread of the cyst into the brain

Initial treatment may involve careful cleaning of the ear, antibiotics, and eardrops. Therapy aims to stop drainage in the ear by controlling the infection. Large or more complicated cholesteatomas may require surgery. Cholesteatomas very often continue to grow if they are not removed. Surgery is usually successful.