Q: When I was younger, I had major bouts of middle ear infections, some of which were treated and some of which didn’t cause pain and went unidentified. I remember my ears feeling plugged and not being able to hear very well. I just went to have my ears assessed, and they are suspecting a hearing loss caused by a cholesteatoma. Would you mind explaining what that means?
A: I would be happy to explain to you everything you need to know about a cholesteatoma. This usually occurs in the middle ear cavity, behind the tympanic membrane (ear drum), causing abnormal skin to grow. Typically a cholesteatoma starts from a non-functioning eustachian tube, the presence of repeated ear infections, or even a perforation of the tympanic membrane that allows skin to grow into the middle ear area.
The eustachian tube is supposed to equalize the pressure between the middle ear and the nasal cavity. When it isn’t able to work correctly, the air in the middle ear is absorbed by the body, creating a vacuum in the ear which then sucks in a pouch, stretching the tympanic membrane. Cholesteatomas usually start out as a cyst or a pouch where old layers of skin stay behind and build up in the middle ear.
Cholesteatomas aren’t present right away; they usually grow slowly over time. If one continues to have ear infections, the cholesteatoma may spread over the ossicular chain, consisting of three little bones in the middle ear called the malleus, incus, and stapes, which may require reconstructive surgery of the ossicular chain. A permanent hearing loss, vertigo, and even facial paralysis may be side effects from the presence of a cholesteatoma.
In rare instances, cholesteatomas can be congenital and present at birth, but cholesteatomas associated with ear infections are the most common type seen.
There are signs that may identify the presence of a cholesteatoma. Patients usually experience fluid drainage with a foul odor from the ear. As the cholesteatoma pouch or sac enlarges, it can cause a feeling of fullness or pressure in the ear along with hearing loss. An ache behind or in the ear, especially at night, may cause significant discomfort. Dizziness or muscle weakness on one side of the face (the side of the infected ear) can also occur. Any or all of these symptoms are good reasons to seek a medical evaluation.
A cholesteatoma is a serious but treatable ear condition. Usually you need a medical examination along with an audiological evaluation to help identify whether there is a hearing loss associated with the cholesteatoma and to determine an appropriate treatment regime. At Northwest Ohio Hearing Clinic, we, along with a team of physicians and other health professionals, have successfully treated many patients with cholesteatoma. If you need any additional information on this subject, feel free to call us or visit our office.
Randa Mansour-Shousher, AuD, CCC-A, is a Doctor of Audiology with Northwest Ohio Hearing Clinic, located at 1125 Hospital Dr., Suite 50 in Toledo (419-383-4012) and 1601 Brigham Dr., Suite 160 in Perrysburg (419-873-4327).