Cholesteatoma Causes Treatment

Cholesteatoma – Causes, Picture, Symptoms and Treatment

Cholesteatoma is an abnormal growth of skin that is benign, in the middle section of the ear behind your eardrum. This can develop as a result of the birth defect but in most cases, this ear health condition occurs as a result of the frequent middle ear infections. If remain untreated it can cause hearing loss because it keeps on growing unless obstructed with proper treatment technique.

The symptoms of cholesteatoma can easily be identified as you will persistently notice issues regarding your ear health including difficulty in maintaining your body balance as it is regulated by the inner ear tissues. It often develops as a sac or cyst form which sheds the old skin layers. Though the cyst is non-cancerous but can crumble tissues and can badly damage your ear health.

There are many theories regarding the process by which cholesteatoma forms but most of the evidence supports that improper functioning of the Eustachian tube leads to the formation of this benign cyst in the middle section of your ear.

The cases where the Eustachian tube doesn’t open up enough as it should be in order to balance the pressures in your middle ear, then a negative pressure develops behind the eardrum. This leads to pulling back your eardrum, developing a pocket. With time this pocket deepens and gets trapped in your ear in the form of a skin cyst or sac.

Just like any other skin tissue of your body, all dead skin cells of the cyst or sac shed off. The sac expands when more amount of dead skin cells slough off leading to cholesteatoma develops. Apart from this, in some cases, the abnormal growth of skin happens around the margin of a perforation onto the middle ear.

Causes

Cholesteatoma
Image Source: -chicagoear.com

Following conditions and reasons is the leading cause behind the cholesteatoma a unique ear disease.

Repeated Middle Ear Infection

A repeated middle ear infection is the most common cause behind the occurrence of cholesteatoma disease. The infection can occur due to colds, allergy, sinus infection, chronic ear infections and sometimes after a surgery Eustachian tube stops working the way as it should work. If not treated on time then a long term existing cholesteatoma can spread to the inner ear and brain of the affected person.

Ear Trauma or Injury

Sometimes perforation occurs in eardrum due to certain injury or from a trauma that develops an opening for the growth of unusual skin cells on the eardrum’s outer surface.

Eustachian Tube Not Working Properly

Eustachian is a tube that connects the backside of the nose with the middle ear together. When this tube stop functioning the way it requires then the eardrums face difficulty in bearing the changes in air pressure level on either side of the eardrum. Resulting in its collapse and turns into a pocket. Over time skin cells, fluids and other wastes buildup into this pocket leading to cholesteatoma develop.

Birth Defect

In very rare cases cholesteatomas develop during the growing phase of a baby inside a mother’s womb. In such cases, some parts of the ear lining get trapped inside the bone with its growth. This usually found at the very early age of childhood. However, in rare cases, babies take birth with a small fragment of skin trapped into the middle ear, known as birth defect problem.

As the cholesteatoma gets larger in size it gets filled with sloughed-off skin cells, fluids and external wastes creating a perfect location for the infection growth. Apart from this issue the growing sac or cyst may increase pressure in the eardrum resulting in the patient may lose his or her hearing ability for a temporary period.

Also if remain untreated a persistently growing larger size cyst may damage the surrounding bones such as bone inside the ear, near the brain and even facial nerves. In this advanced stage of cholesteatoma permanent hearing loss possibility remains quite high.

Symptoms

symptoms of cholesteatomaThe symptoms of cholesteatoma may vary from person to person depending upon the period from which it is present including-

  • Temporary loss of hearing (If treatment not given on time)
  • Permanent loss of hearing (If the delay happens in the treatment of long-existing cholesteatoma)
  • Tinnitus i.e. a constant sound inside the ear.
  • Ear pressure
  • Dizziness or vertigo
  • Aching pain either behind or inside the ear.
  • Ear infection
  • A feeling of fullness in one ear
  • Difficulty in hearing by one ear
  • Continuous Drainage of foul-smelling fluid
  • Weakness in half side of the face
  • Facial muscle paralysis

A long term cholesteatoma concern especially which remains untreated can spread into other areas of the ear such as the part which is used for maintaining the balance. In more serious cases it converts into a severe inner ear and brain infection. Resulting in pus-filled swelling occur in the brain on meningitis. However, this is a rare condition.

Complications

An untreated cholesteatoma persistent for longer duration can grow larger in size and may cause several complications including mild to severe. Over time the accumulation of dead skin cells in the ear creates a suitable environment for the bacteria and fungus thrive. This causes infection in the non-cancerous cyst or sac existing in the middle ear leading to continuous ear drainage and inflammation happens.

If this happens then the cholesteatoma has the potential to destroy the surrounding bones. As a result of this, damage can happen in the eardrum, inside bones of the ear, bones near the brain and even facial nerves (face paralysis). If the bones within your ear are damaged then it can cause permanent hearing loss. That means it cannot be recovered even after the treatment.

An untreated cyst grows larger over time and spread into the face area causing the facial weakness. Apart from these major complications some other potential complications associated with the cholesteatoma disease includes the following-

  • Swelling in the inner ear
  • Chronic ear infection
  • Facial muscles paralysis
  • Accumulation of pus in the brain or brain abscesses
  • Life-Threatening brain infection is known as Meningitis

In order to avoid these major complications risk which is life-threatening too, the symptoms of a cholesteatoma must not be ignored under any condition.

Diagnosis

In order to check whether cholesteatoma has affected your hearing ability or not, and if yes then what extent your, a doctor will take the sounds test by letting you listen to different level sounds. The physical examination of the internal area of your ear will be done with the help of a medical instrument known as an otoscope that contains a magnifying glass and a light on its surface.

If the doctor notices the sign of cholesteatoma disease then they will recommend you consult with the specialist of ear, nose and throat organs. Once you visit the specialist doctor they will ask you to take the following imaging tests that will look closely the wide picture of your cholesteatoma.

CT Scan or Computerized Tomography

This particular imaging test shows a very detailed picture of your internal ear areas such as soft tissues, blood vessels, and bones. The minute detail of each and every part of your inner ear in the CT scan imaging test report helps in evaluating your doctor whether the cholesteatoma has grown up to your ear bones or not. If the cholesteatoma spreads to the bones of the ear then it can interfere with its balancing and hearing functions.

This diagnosis test gets more necessary under the cases where your doctor thinks that surgery is the only treatment option that can relieve your condition. The images will let the doctor analyze what is the actual scenario of your inner ear before they start the surgery procedure.

MRI or Magnetic Resonance Imaging

If in CT scan imaging test something suspicious noticed that your doctor thinks to need a much close and wider view then they will ask for taking the MRI test. This MRI report usually helps in detecting whether an infection has spread up to the brain area or not. This test is very reliable and helps the specialist doctor to take further treatment steps.

Treatment of Cholesteatoma

There is no medicine that can completely remove the sac or cyst growth in the middle ear and its associated symptoms caused by cholesteatoma. It generally needs surgery in order to remove and cure all associated troubles.

This surgery usually takes only 2 to 3 hours time so the patient needs not requires staying in the hospital. That means you can get back to your home on the same day when the surgical procedure is done. For comfort, the patient is given medicine so that they can sleep easily without any discomfort. The removal is done via either of the two below mentioned ways-

  • Mastoidectomy- In this procedure mastoid which is a bone behind the ear open up by the surgeon to the level by which the cyst removal could be possible easily.
  • Tympanoplasty- In this procedure eardrum or tympanic membrane damages are fixed. The holes in the eardrum that is already created due to the cholesteatoma are filled with the cartilage or muscle from another area of the ear by the surgeon.

The surgery procedure helps in recovering the hearing loss to some extent but this doesn’t get possible in every other case. If the cholesteatoma is not removed completely then chances of their recurrence in the future remain very high. So if anyone undergone the surgical procedure for the removal of a cholesteatoma must go for the follow-up visits on a regular basis to ensure whether any unusual growth has occurred in their inner ear or everything is fine.

In any condition, the cholesteatoma should not be left untreated as if necessary treatment is not provided on time then it can cause lifetime deafness that cannot be recovered, bone loss, facial paralysis, meningitis, and other such devastating effects. The minor form of cholesteatoma can be treated through the professional ear cleaning along with the full antibiotic treatment.

However, this treatment procedure doesn’t work in the cases of more aggressive form off cholesteatoma. In such cases mostly the mastoidectomy surgery procedure is used for the removal. In order to avoid the cholesteatoma recurrence and growth risk in the future the patient’s inner ear should be monitored in the routine checkup.

Cholesteatomas Prevention Tips

The cholesteatoma is not a preventable condition. However, in order to avoid childhood cholesteatoma from getting aggressive, the parent should remain aware of all its symptoms and signs so that it can be easily identified and treated in its preliminary stage. Early-stage treatment can save a child from the worst possible complications that persist with a long term cholesteatoma disease and a more invasive form of treatment procedures such as surgery.

Cholesteatoma in more advanced stages of life like at a young age or in a more matured age of life can be prevented by not avoiding frequent ear infections. Give proper and immediate treatment to any of your ear infections so that it won’t spread or get aggressive in the lack of timely treatment.

If you diagnosed with cholesteatoma then don’t make a delay in its further treatment to prevent its complications. Immediately visit a specialist doctor if you suspect that you have developed the cholesteatoma without delay. Early-stage treatment is the only way to prevent health complications associated with cholesteatoma.

Conclusion

The cholesteatoma complications are not very common as most of the cyst are caught and removed in the very early stage. So eardrum damage and other inner bones and tissue damage don’t happen generally. However, before identifying the symptoms of cholesteatoma if the sac or cyst gets larger in size or more complex then chances remain high that the permanent hearing loss has happened.

Dizziness and vertigo are the most common signs of a larger size cyst that turns complicated. This is the reason why it is important for each and every individual especially parents of newborn babies to have thorough knowledge about the symptoms of this severe ear disease. However, even if the cyst gets larger in size still it is a treatable condition with the help of surgery.

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