Cholesteatoma Causes, Symptoms, and Treatment

A cholesteatoma is an abnormal, noncancerous skin growth in the middle ear, behind the eardrum. Unless treated, it can cause hearing loss as it continues to grow in size.

Causes of Cholesteatoma

A cholesteatoma can occur in any of several ways:

• Cholesteatomas are most often caused by repeated middle-ear infections. If not treated, infection from a long-established cholesteatoma can spread to the inner ear and brain.
• Some people are born with a small remnant of skin that is trapped in the middle ear, but this is rare.
• A perforation of the eardrum (for example, from infection or trauma) can provide an opening for the skin of the eardrum's outer surface to grow through.
• Chronic ear infections, sinus infections, allergies, and colds can affect the Eustachian tube (connecting the back of your nose to your middle ear), keeping it from doing its job of equalizing air pressure on either side of your eardrum. This can cause a partial vacuum in your middle ear that pulls a section of your eardrum into it. This eardrum tissue becomes a cholesteatoma.
• As it grows larger, the cholesteatoma fills with sloughed-off skin cells, fluids, and other wastes, creating an ideal environment for infection. The growing cyst also increases pressure in your ear, which can cause hearing loss. If it grows very large, it can destroy surrounding bone, damaging your eardrum, the bones inside your ear and near your brain, and/or your facial nerves. At this stage, permanent hearing loss can occur.

What It Looks Like

A cholesteatoma resembles a pouch with layers of old skin. Quite a few websites have photographs of cholesteatomas (some are not for the squeamish). Here are two:

• EntUSA.com has 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 mastoid surgery pictures that include an example of a cholesteatoma that has worked its way up through the skin.

Symptoms

Depending on how long it's been present, symptoms of a cholesteatoma may include:

• Hearing loss, which may be temporary (if treated early) or permanent
• Ear pressure
• Aching pain behind or in your ear
• Vertigo (a sense of whirling around and loss of balance)
• Drainage of a foul-smelling fluid
• Facial muscle paralysis

Treatment

A cholesteatoma must be treated to prevent or control deafness, meningitis, facial paralysis, bone loss, and other unwanted effects. 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

Published books about cholesteatoma and treatments 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.