| Cholesteatoma FAQ |
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What is a cholesteatoma? It’s a benign tumor in the middle ear that starts with an abnormal growth of skin. It usually results from a severe infection following a perforated eardrum. If it is not treated promptly, it can progress farther into the ear and destroy the bones of the middle ear. In some cases, cholesteatomas have a genetic cause. But congenital cholesteatomas are much less common. It’s a “benign” tumor. Does that means it’s not dangerous? No. It’s a very serious condition that requires immediate attention. “Benign” simply means it’s not cancerous. Cholesteatoma is rarely life-threatening, but it can lead to deafness. Left untreated, it can even result in brain infection and permanent facial paralysis. How can a benign tumor of the middle ear lead to brain infection? The cholesteatoma contains an enzyme that eats away at bone. It can attack the mastoid bone, which separates the ear and the brain and which is very thin. Brain infection is not a common result of a cholesteatoma, but it does happen in especially severe cases. There are many causes of hearing loss. How would I know if I had a cholesteatoma? Hearing loss would be one of the first symptoms, but not the only one. You’d usually also notice a discharge from the ear. Often the discharge will have a very unpleasant odor. If it’s not treated, it can lead to deafness, dizziness and severe imbalance. There may also be numbness or even paralysis of the facial muscles. But even those symptoms could have other causes, so it’s up to your otologist to make the definitive diagnosis. In the case of a congenital cholesteatoma, which grows somewhat differently than the more common cholestatoma associated with infection, there are often no symptoms until it becomes quite large. Congenital cholesteatomas start growing at birth, and often a child’s pediatrician will detect the cholesteatoma visually during a regular examination and will refer the child to an otologist. How is a cholesteatoma treated? In most cases, the otologist will initially concentrate on treating the infection within the ear. He or she will dry the infection within the ear, then clean it weekly using a surgical microscope and prescribe oral, otic or intravenous antibiotics. It’s not unusual for two or three different types of antibiotics to be used to fight the infection. So does that mean it doesn’t require surgery? Actually, it often does. First of all, polyps, which are growths of inflamed tissue, often accompany a cholesteatoma. Sometimes they will shrink on their own, but often they have to be removed surgically. That has to be done before the infection can be treated. Besides, the cholesteatoma itself often requires surgical removal. The first step is to clear up the infection. After that, the otologist will determine whether surgery is called for. (In congenital cholesteatomas, no infection is present, so surgery can be performed much sooner.) Your otologist may require a CT scan (also known as a CAT scan) to determine how far the cholesteatoma has grown into the ear, and whether it has affected the mastoid bone and the brain. What is involved in the surgery? That depends on how far the cholesteatoma has progressed. If it’s small, it can sometimes be removed microscopically through the ear canal. If the cholestaetoma has affected the bone that separates the ear from the brain covering, the otologist may recommend a much more severe procedure called a mastoidectomy. The mastoidectomy involves actually removing that wall of bone. The result is an open cavity that requires follow-up treatment for the rest of the patient’s life, and the patient must be scrupulous about keeping the ear dry. Besides that ongoing treatment, mastoidectomies require later, secondary surgery to restore hearing. Even after that surgery, though, hearing loss can be permanent. Masteoidectomies used to be much more common than they are today; in fact, they were performed in virtually all cases in which a cholesteatoma affected the mastoid bone. These days, though, mastoidectomies are generally performed only in especially severe cases. Today’s more common, much less radical, procedure is called an intact canal wall operation. In that procedure, the bony wall is left intact. That operation is much less damaging to the ear canal and eardrum. It’s easier for the patient to recover all of his or her hearing, and in most cases the patient can even allow water into the ear canal. A secondary operation to repair bone and restore hearing may still be necessary. Once the cholesteatoma is removed, can it grow back? Yes. Somewhere between 10 and 20 percent of cholesteatomas grow back, even if they’ve been surgically excised. Choleseatomas in children grow back significantly more often. One of the advantages of a mastoidectomy, as opposed to the intact canal operation, is that it makes it easier for the otologist to see a regrowth of a cholesteatoma. Is there anything I can do keep it from growing back? No. But it’s absolutely necessary that you follow your otologist’s recommendations for follow-upo visits. The otologist will watch for any signs of recurrence to make sure it is detected as early as possible. Catching a re-growing cholesteatoma early will make further surgeries less invasive and will help guard against hearing loss. If I’ve had a mastoidectomy, will I get my hearing back? Almost always, but only after a subsequent operation to repair the bone. In fact, your hearing could actually be better after the secondary operation than it was before the mastoidectomy. But in some cases, the damage to the ear from the cholesteatoma makes the restorative surgery impossible. In those cases, a hearing aid can usually help restore hearing. |