A cholesteatoma is an abnormal, noncancerous skin growth that can develop in the middle ear space just behind the eardrum. It’s most commonly caused by repeated, untreated middle ear infections but may also be a birth defect. Cholesteatomas may cause hearing loss, balance trouble, and dysfunction of the facial muscles. They are somewhat rare, with the annual incidence of cholesteatomas being 9-12 cases per 100,000 adults and 3-15 case per 100,000 children.
Causes of cholesteatomas
Repeated and often untreated ear infections are the main cause of cholesteatomas. Along with repeated ear infections, they may also be caused by a poorly functioning eustachian tube (the tube that leads from the back of the nose to the middle ear space). The purpose of the eustachian tube is to allow air to flow from the back of the throat to the middle ear space and to equalize middle ear pressure. Allergies, colds, sinus infections, chronic ear infections, and structural abnormalities of the eustachian tube can cause the eustachian tube to malfunction or stay closed for too long, causing negative ear pressure to develop. This can cause a partial vacuum to occur in the middle ear space. The vacuum may pull part of the eardrum into the middle ear space, creating a cyst that can turn into a cholesteatoma. This growth or cyst then becomes larger as it fills with old skin cells, fluids, and other waste materials.
The symptoms of cholesteatoma start out mild and become more severe as the cyst grows larger and occupies space in the middle ear cavity. Initially, drainage may leak from the ear canal. As the cyst grows, it can cause a pressure or aching sensation to develop in the ear or behind the ear. It can also cause hearing to decrease by not allowing the eardrum or bones of the middle ear to move properly. Some people report tinnitus (ear ringing or humming) as a symptom. Along with ear pain, pressure, or tinnitus, other symptoms include dizziness or balance trouble as well as facial muscle weakness or paralysis.
If left untreated, a cholesteatoma will grow larger and cause destruction of the surrounding bone. It can also damage the eardrum, bones of the ear, and nerves of the face. The cholesteatoma can also allow bacteria and fungi to thrive, causing infections in the middle ear space and even into the meninges of the brain. This can become a life-threatening situation, so prompt medical care is necessary.
An ear, nose and throat physician will determine the presence of a cholesteatoma by examining the ear canal and eardrum using an otoscope. He or she will be looking for eardrum abnormalities. A CT scan may need to be ordered if symptoms such as dizziness or facial muscle weakness are seen. A complete hearing evaluation by an audiologist will also be performed to assess middle ear function and hearing ability.
The only way to treat a cholesteatoma is to surgically remove it. The cyst must be removed to prevent complications from it growing larger, eroding the middle ear bones, or infecting the area surrounding the ear, including the lining of the brain. Cholesteatomas do not go away naturally and usually continue to grow and cause problems.
Once diagnosed, treatment of the cholesteatoma typically includes a regimen of antibiotics, ear drops, and cleaning of the ear canal by the ear, nose and throat physician to treat the infected cyst, reduce inflammation, and drain the ear. Following that initial treatment, a plan for surgical removal is made.
In most cases, the surgery is performed on an outpatient basis under general anesthesia. A hospital stay may be required if the cyst is very large or serious infection is present. After the initial surgery for cyst removal, there may be a need for follow-up surgery to reconstruct any damage to the ear caused by the cyst.
Follow-up appointments with the surgeon will be necessary to evaluate the result of the surgery and to be sure that the cyst has not returned. Some side effects of the surgery for some people are temporary dizziness and taste abnormalities. These side effects typically resolve within a few days.
Another treatment after surgery may be a hearing aid to restore hearing lost from the cholesteatoma. Various options for amplification must be explored by the patient and audiologist to find the most appropriate option for the medically treated ear.
Cholesteatomas can be prevented by treating ear infections as well as treating causes of chronic eustachian tube dysfunction. However, cysts may still occur. It’s important to treat cholesteatomas as early as possible to prevent complications. Call your doctor right away if you believe you have a cholesteatoma. Symptoms of repeated ear infections, ear pain, drainage, pressure, dizziness, and facial weakness should be evaluated by a physician. An audiologist can test hearing and middle ear function and refer to an ear, nose and throat physician if middle ear hearing loss and dysfunction is present.
Call the audiologists at Northwest Ohio Hearing Clinic at 419-383-4012 or 419-873-4327 if you have any questions about your hearing, ears, or balance.❦