A cholesteatoma is a cyst which forms in the middle ear and consists of skin cells and debris. Normally, the ear canal debris moves to the outer ear with the help of earwax. In case the eardrum is ruptured, then the skin debris may move in to the middle ear and form a cyst.
It is an expanding and vicious growth that can cause major problems given its erosive property causing a lot of destruction of the bones of the middle ear and can also spread into the brain.
If untreated, a cholesteatoma can wipe out the small bones situated in the middle ear and this can cause impairment and deterioration of the nerve, vertigo and deafness. Furthermore, the infection can also travel to the brain and cause infection with serious complications there, sometimes even death.
There are 2 kinds of cholesteatoma – congenital cholesteatoma and acquired cholesteatoma.
- Congenital cholesteatoma: It is a middle ear epidermal cyst which develops deep within an intact ear drum.
- Acquired cholesteatoma: It is commoner, and is usually caused an infection of the ear drum causing a build-up of keratin in the middle ear which forms a cyst.
Thus, it is very vital that a prompt diagnosis is made and the most optimal treatment regimen started immediately.
Sign And Symptoms Of Cholesteatoma
The signs and symptoms include:
- Ear discharge from the affected ear.
- Buzzing or ringing in the ear (tinnitus).
- Sometimes, bleeding from the ear.
- Hearing loss
- Pain in the ear
- Loss of balance (loss of balance is a serious issue; given that, it means the cyst is damaging the inner ear).
- If a patient presents with these symptoms, it is very crucial that cholesteatoma is considered as a likely diagnosis until the disease is unquestionably excluded.
- When the doctor examines the ear, the ear canal will be full of discharge. Until the physician has cleaned the ear and examined the tympanic membrane, cholesteatoma cannot be verified or negated. He will also order a few tests and investigations to confirm the analysis.
Surgical Treatment Of Cholesteatoma
- Once the diagnosis of cholesteatoma has been established, habitually, the person is given a general anesthetic; the standard treatment regimen is to surgically excise the growth without delay.
- Surgical intervention comprises of permanently removing the cholesteatoma whilst preserving or reconstructing the normal functions of the surrounding structures.
- The chief aim of the surgery is to get rid of the underlying pathology and to sustain normal functioning of the temporal bone. This makes a cholesteatoma surgery exceptionally challenging and complicated.
- The need to remove a progressive disease like cholesteatoma wholly is the surgeon’s main concern. Preservation of hearing is secondary. If it is possible to entirely remove the cyst with no risk of any residual disease, then the ossicles are generally preserved. On the other hand, in case the disease is too complicated to remove, and there is a risk of residual disease, then the ossicles need to be excised as well in order to completely clear the case.