Cholesteatoma is a disease of ear in which there is abnormal growth of skin in middle ear and mastoid bone. This skin cyst is not malignant but can cause destruction of delicate structures of middle ear as it increases in size. It may lead to hearing loss, vertigo, pain in the back of ear and paralysis of facial muscles.
Repeated middle ear infection is the primary etiological factor for development of cholesteatoma. Dysfunction of Eustachian tube is another important cause that may lead to cholesteatoma after prolonged period of time. Conservative treatment is not effective for cholesteatoma.In almost all cases surgical removal of the cholesteatoma cyst is the treatment of choice.
What Are The Causes Of Cholesteatoma?
Cholesteatoma is not as common as other ear diseases. But when occurs it causes destruction of the tissues and structures of middle ear. Frequent bacterial infection of middle ear and dysfunction of Eustachian tube are two important risk factors for development of Cholesteatoma.
The Eustachian tube is connected from back of nose to the middle ear. Its main function is to maintain equilibrium of air pressure in the middle ear. When the eustachain tube does not function properly or gets blocked, vacuum is created in the middle ear.
This vaccum may pull the eardrum into the middle ear leading to formation of a sac which over a period of time will transform into Cholesteatoma. It may increase in size with skin cells, fluid and debris. Cholesteatoma can also occur after an injury and damage to the eardrum. In rare cases Cholesteatoma can occur since birth.
Symptoms Of Cholesteatoma
The symptoms of cholesteatoma are mild to start with. But as the sac grows in size, the symptoms become severe and cause destruction of the middle ear structures. In the beginning the affected ear may drain foul smelling thin watery discharge.Gradually cholesteatoma cyst enlarges in size. With expansion it starts corroding the mastoid bone and the structures of the middle ear. This leads to loss of hearing of the affected ear.
Patient may also experience dizziness and paralysis of muscles of face. Pain behind the ear is severe when cholesteatoma compresses the bone. Bone erosion can spread to the surrounding structures including inner ear and brain. Untreated cases may lead deafness, brain abscess, meningitis, etc.
Treatment For Cholesteatoma
Conservative treatment does not cure cholesteatoma. Surgical removal is the only option for complete cure of the disease. The sac or the cyst is removed to prevent complications which may occur when the sac starts growing larger in size.
After the diagnosis of cholesteatoma, the ENT surgeon may prescribe antibiotic ear drops and oral antibiotics. He will also clean the ear and remove the foul discharge from the ear. He will be able to clinically asses better after cleaning the ear and examining the patient. He will plan accordingly to remove the cyst surgically.
Surgery is performed under general anesthesia. Patient may have to stay for a day in the hospital after the surgery. After the removal of cyst, follow up surgery may be required to reconstruct and repair the damaged structures of middles ear.
During the recovery period and few months later, patient may have to avoid swimming, and other strenuous sports activities.