Cholesteatoma is an abnormal skin growth that develops in the middle ear, the space on the other side of the eardrum.
Recurrent infections and/or damage to the eardrum lead to inward pulling of the eardrum. Overtime this leads to formation of a skin cyst. As the cyst grows it can damage structures in the area.
The underlying cause of cholesteatoma formation is eustachian tube dysfunction. The eustachian tube is a bony-cartilaginous canal that connects the middle ear (space on the otherside of the eardrum) with the back of the nose. This tube allows us to equalize the middle ear pressure with environment (clear or pop the ears). When the eustachian tube does not allow the pressure to equalize it is dysfunctional. Overtime the negative pressure that builds up leads to inward pulling of eardrum and cholesteatoma formation.
The most common symptom of cholesteatoma is drainage from the affected ear. As it enlarges pressure, pain, and hearing loss develop. In severe cases dizziness and facial paralysis can occur.
The diagnosis of cholesteatoma is usually made by an otolaryngologist by looking in the ear. An audiogram/hearing test is always performed. CT scans and occasionally MRIs are obtained to confirm the diagnosis and plan treatment.
The treatment of cholesteatoma is surgery. Medicines cannot fix this problem. Surgery is typically performed under general anesthesia. The goal of the surgery is to completely remove the skin cyst to create a safe dry ear. In some patients a second surgery is necessary six to twelve months later to reconstruct the middle ear bones and improve hearing.
Most patients go home the same day after surgery. Usually 1-2 weeks off work is necessary. Patients are seen after surgery for regular ear cleanings and monitored for recurrence.