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CholesteatomaWhat Is A Cholesteatoma? A cholesteatoma is a skin growth that occurs in an abnormal location, themiddle ear behind the eardrum. It is usually due to repeated infection, which

causes an ingrowth of the skin of the eardrum. Cholesteatomas often takethe form of a cyst or pouch that sheds layers of old skin that builds up insidethe ear. Over time, the cholesteatoma can increase in size and destroy thesurrounding delicate bones of the middle ear. Hearing loss, dizziness, andfacial muscle paralysis are rare but can result from continued cholesteatomagrowth.Causes Of Cholesteatoma A cholesteatoma usually occurs because of poor eustachian tube function aswell as infection in the middle ear. he eustachian tube conveys air from theback of the nose into the middle ear to e!ualize ear pressure "#clear theears#$. %hen the eustachian tubes work poorly perhaps due to allergy, a coldor sinusitis, the air in the middle ear is absorbed by the body, and a partialvacuum results in the ear. he vacuum pressure sucks in a pouch or sac bystretching the eardrum, especially areas weakened by previous infections.

his sac often becomes a cholesteatoma. A rare congenital form ofcholesteatoma "one present at birth$ can occur in the middle ear andelsewhere, such as in the nearby skull bones. However, the type ofcholesteatoma associated with ear infections is most common.Cholesteatoma Symptoms Initially, the ear may drain, sometimes with a foul odor. As the cholesteatomapouch or sac enlarges, it can cause a full feeling or pressure in the ear, alongwith hearing loss. "An ache behind or in the ear, especially at night, maycause significant discomfort.$ &izziness, or muscle weakness on one side ofthe face "the side of the infected ear$ can also occur. Any, or all, of thesesymptoms are good reasons to seek medical evaluation.Is It Dangerous? 'ar cholesteatomas can be dangerous and should never be ignored. (oneerosion can cause the infection to spread into the surrounding areas,including the inner ear and brain. If untreated, deafness, brain abscess,meningitis, and rarely death can occur.Treatments For Cholesteatoma An e)amination by an otolaryngologist*head and neck surgeon can confirmthe presence of a cholesteatoma. Initial treatment may consist of a carefulcleaning of the ear, antibiotics, and ear drops. herapy aims to stop drainage

in the ear by controlling the infection. he e)tent or growth characteristics ofa cholesteatoma must also be evaluated.+arge or complicated cholesteatomas usually re!uire surgical treatment toprotect the patient from serious complications. Hearing and balance tests, )*rays of the mastoid "the skull bone ne)t to the ear$, and CA scans " *& )*rays$ of the mastoid may be necessary. hese tests are performed todetermine the hearing level remaining in the ear and the e)tent ofdestruction the cholesteatoma has caused.

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-urgery is performed under general anesthesia in most cases. he primarypurpose of the surgery is to remove the cholesteatoma and infection andachieve an infection*free, dry ear. Hearing preservation or restoration is thesecond goal of surgery. In cases of severe ear destruction, reconstructionmay not be possible. acial nerve repair or procedures to control dizzinessare rarely re!uired. /econstruction of the middle ear is not always possible inone operation0 and therefore, a second operation may be performed si) totwelve months later. he second operation will attempt to restore hearingand, at the same time, inspect the middle ear space and mastoid for residualcholesteatoma.Admission to the hospital is usually done the morning of surgery, and if thesurgery is performed early in the morning, discharge maybe the same day.

or some patients, an overnight stay is necessary. In rare cases of seriousinfection, prolonged hospitalization for antibiotic treatment may benecessary. ime off from work is typically one to two weeks.

ollow*up office visits after surgical treatment are necessary and important,because cholesteatoma sometimes recurs. In cases where an openmastoidectomy cavity has been created, office visits every few months areneeded in order to clean out the mastoid cavity and prevent new infections.In some patients, there must be lifelong periodic ear e)aminations.Summary Cholesteatoma is a serious but treatable ear condition which can only bediagnosed by medical e)amination. 1ersisting earache, ear drainage, earpressure, hearing loss, dizziness, or facial muscle weakness signals the needfor evaluation by an otolaryngologist*head and neck surgeon.