Cholesteatoma is the formation of a cyst of skin in the ear. They are occasionally congenital, but are frequently occur as a complication of chronic otitis media and/or Eustachian tube dysfunction, The cyst consists of layers of skin (epithelium), and are benign tumors that may be locally destructive. They can become infected and cause drainage of liquid or pus out of the ear. They often cause additional hearing loss as they interfere with the vibration of the eardrum or ossicles.
When left untreated other rare but very severe complications of chronic otitis media and cholesteatoma include mastoiditis, erosion of and infection in the inner ear (labyrithitis), brain and facial nerve resulting in vertigo, balance loss, deafness, meningitis, brain abscess and facial paralysis. Cholesteatoma Images
The treatment of chronic otitis media and cholesteatoma is usually surgical. The draining ear is usually cultured to identify bacteria and antibiotic therapy is often initiated prior to surgery. CT and MRI studies are used to evaluate the extent of disease, status of the ossicles, important anatomic structures and the extent of infection. Tests of balance may be ordered if the inner ear is involved. Small cholesteatomas can sometimes be watched, but most need surgery to remove them. Surgery is frequently required to remove chronic infection, cholesteatoma and reconstruct the eardrum and ossicles. The operation is usually performed as a tympanomastoidectomy. Occasionally more extensive procedures are required for their removal. Because of their high recurrence rate, a second stage procedure is usually performed 6-12 months later to insure the entire cyst was removed during the first surgery, the so-called second look procedure.
Hearing loss if frequently improved with surgery but normal hearing can not always be completely restored to patients with severe chronic otitis media. This can be because of the presence of a sensorineural or mixed loss, or because scar tissue, Eustachian tube dysfunction and other anatomic problems do not allow for complete return to normal hearing. Hearing aids or bone conduction devices may be recommended for patients in these categories.
