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Cholesteatoma Causes, Diagnosis, and Treatment

Early detection key to prevent hearing loss


Updated October 02, 2013

Cholestetoma is a cause of hearing loss but if you catch it early, you can reduce or slow the damage it can cause to your ears and hearing. Therefore, it's important to know what causes cholesteatoma, as well as the signs and symptoms.

What Is a Cholesteatoma?

In its simplest definition, a cholesteatoma is a skin growth in the middle ear behind the eardrum. A normal ear canal is lined with skin that constantly sloughs off and and is carried out of the ear by ear wax. Sometimes this process doesn't work correctly.

What Causes Cholesteatomas?

A cholesteatoma can form in a few ways. Some people are born with a small remnant of skin that is trapped in the middle ear, but this is rare.

Also, a perforation of the eardrum (from infection or trauma) can provide an opening for the skin of the outer surface of the eardrum to grow through.

In many cases, repeated ear infections can aggravate the Eustachian tube, causing negative pressure to build in the middle ear. Additionally, an improperly functioning Eustachian tube can cause repeated ear infections. Either way, over time, the eardrum retracts toward the inner ear. Eventually, a skin-lined sac can form, which continues to grow, and can cause destruction of bone and lead to infection.

What Does a Cholesteatoma Look Like?

A cholesteatoma resembles a pouch with layers of old skin. Quite a few websites have photographs of cholesteatomas. Here are a few (some are not for the squeamish):
  • EntUSA.com - Includes photographs showing the formation of a cholesteatoma. The same site has photographs of surgery, including a picture of a large cholesteatoma that was removed.
  • Otolaryngology Houston has more mastoid surgery pictures, including an example of a cholesteatoma that has worked its way up through the skin.

What Are the Symptoms of a Cholesteatoma?

The symptoms that a cholesteatoma is present include:
  • hearing loss
  • dizziness
  • ear pressure
  • drainage

How Can a Cholesteatoma Be Treated?

A cholesteatoma must be treated to prevent or control deafness, meningitis, facial paralysis, and other effects. If a cholesteatoma is not treated the infection can damage bone, and spread to the inner ear and brain. More serious cholesteatomas are removed surgically, often through a mastoidectomy. Minor ones can be treated with professional ear cleaning and antibiotic treatment. After treatment is complete, the patient must be monitored because a cholesteatoma can recur.

Resources on Cholesteatoma

Published books about cholesteatoma and treatmente= include:
  • Cholesteatoma - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References
  • Surgical Treatment of Middle Ear Cholesteatoma
Further research can be found in the National Library of Medicine's PubMed database.

Support for People with Cholesteatoma

Yahoo Groups has a large and active support group, "Cholesteatoma."

Personal Experiences with Cholesteatoma

An About.com Deafness/HOH visitor shared his personal experience with cholesteatoma:

"I have been HOH (hard of hearing) since the age of 2 years. I began wearing hearing aids at age 9 years. I was prone to ear infections and due to the birth anomaly -- cleft lip and palate -- my Eustacian tubes do not function properly. At age 23 years, I was diagnosed with cholesteatoma tumors in both ears.

I had a 50/50 chance of going deaf or improving my hearing. I came out of my surgery being able to hear the crickets, birds singing, etc., to the point of having to wear huge padded ear muffs like they use on the gun range. The hearing lasted three months before returning to my previous level with additional losses as time passed.

I have had an additional nine surgeries for recurring tumors and to the present date I am planning another surgery soon for another. The last time I told the doctor I had another tumor, he looked in my ear and said there was none, but the silastic sheet they placed in there the last time, was poking through my eardrum and there was another hole besides. He mentioned surgery to remove that and repair the eardrum. I said, "Let's go, when can we do it." He was not in a hurry, but I knew better after having eight previous tumors.

I went in the following week and when I came out of recovery, my only statement was, "Well was there a tumor"? The doctors were embarrassed, but told me "you scared the hell out of us, there was a tumor and it destroyed the stape so we had to put a prosthetic stapes in place and we decided to try another form for the eardrum. They replaced the eardrum with a cartilage graft instead of the standard vein graft." What was to be an 1 1/2 hour surgery became five hours.

Now doctors are listening to me when I say there is a tumor, as I have almost mastered the signs of their growth pattern. One thing is imperative: Anyone who has had these tumors...don't mess around, listen to your body. Demand to have CT or MRI scans every six months to a year regularly. My doctors have never ordered the scans because I am a Medicare/Medicaid client. They never told me about the process of watching and having routine scans to monitor the recurrence. I did research to find out what I know to this day and I demanded the scan and finally had one that revealed my present tumor, otherwise I would have been ignored and left to endure more deadly consequences.

I am presently a candidate for the bone anchored cochlear implant, but due to Medicare/Medicaid not understanding that the implant is a prosthetic device and not a true hearing aid, I do not receive the necessary hearing assistance to be a functional individual in our society.

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