Cholesteatoma

A very important piece of ear anatomy, the eardrum is a thin piece of tissue that separates the outer and middle ears from the inner ear. Cholesteatoma is an abnormal growth of skin cells that develops on or inside any part of this membrane. Left untreated, this sac of dead skin cells forms in a pocket in your middle ear and slowly gets larger, eventually filling your middle ear and mastoid bone, leading to hearing loss.

While it may resemble a cyst or a tumour, a cholesteatoma is not cancerous. It can, however, cause hearing loss, ear pain, and even infection if not treated, and may damage important ear structures like bones and the eardrum – so it’s important to attend regular hearing and ear checkups to catch and treat cholesteatoma early to preserve your ear health.

There’s no single cholesteatoma cause, with both congenital and acquired factors playing a potential role in the development of this condition.

While cholesteatoma can be a birth defect, it usually forms due to weakness in the area caused by infection, injury or poor Eustachian tube function. 

The Eustachian tube normally equalises pressure within the ear, but when it’s not working as it should, this can result in a vacuum effect, drawing skin cells into the middle ear and leading to the growth of a cholesteatoma.

Chronic ear infections – often stemming from bacteria trapped within the cholesteatoma – can worsen the problem, making it clear that this issue is best attended to sooner rather than later. Getting regular ear and hearing checks and being aware of the symptoms can be crucial in early cholesteatoma diagnosis and treatment.

While antibiotics and regular cleaning can help keep infection and smelly discharge at bay, surgery is the only way to remove a cholesteatoma. Cholesteatoma surgery is performed under a general anaesthetic by an ear, nose, and throat (ENT) surgeon and usually takes around two to three hours. The aims of cholesteatoma surgery are threefold: to remove the sac of skin, repair any damage already done to the ear’s delicate structures and restore hearing as best as possible.

Cholesteatoma surgery typically involves two different procedures – tympanoplasty and mastoidectomy. Tympanoplasty focuses on repairing the eardrum, middle ear bones and other affected structures to restore hearing function. Essentially, it is the surgical reconstruction of the middle ear.

Mastoidectomy, on the other hand, involves removing any infected bone, as well as the sac of skin, to eliminate the source of infection and prevent its spread. It also involves repairing any holes in the eardrum.

While you should be able to go home the day after surgery, it can take up to three weeks before people who’ve had these procedures get back to work, and proper postoperative care is essential for maintaining ear health.

Patients must follow post-surgery instructions carefully, which may include avoiding water exposure to the ear, taking medications and attending follow-up appointments. Regular check-ups are vital to prevent recurrence, which can happen if any of the cholesteatoma is left behind. It’s important to communicate with your specialist, and if you have any concerns, get in touch with them.

Left unchecked, cholesteatoma poses risks of hearing loss, infections and pain, and prompt diagnosis through visual exams, hearing tests and CT scans is vital. Though non-cancerous, cholesteatoma’s impact on ear structures means the need for timely treatment is essential, and early intervention is key to preserving not only your ear health but also your hearing.