Saturday, August 12, 2017

Cholesteatoma Symptoms, Diagnosis, Treatment and Mastoidectomy Operation

Cholesteatoma Definition

Cholesteatoma is a rare abnormal collection of skin cells in your ear. It behaves like a tumoral tissue and has features that can damage the surrounding bone tissue, and in time, the brain around it, the brain, the facial nerve. It is composed of skin cells, trapped in the form of an inflammation ball. Cholesteatomas usually develop as cysts or pouches, while migrating old skin layers that accumulate in the middle ear. Over time, the cholesteatoma may increase in size and break down delicate bones in the middle ear, causing hearing loss.

Cholesteatoma is an abnormal, non-cancerous skin growth that can develop in the middle ear, behind the eardrum. There may be a birth defect, but it is often caused by repeated middle ear infections. Cholesteatoma is the accumulation in the middle ear or other pneumatized areas of the temporal bone, which should not be a keratinized multi-layer flat epithelium. It is a histologically benign but clinically destructive lesion. How the multi-layered flat epithelium came to the middle ear and how it started to become hyperkeratin is still controversial despite many studies.

Chronic otitis media is a persistent form of various types of otitis media that develop over the years. The disease can manifest with different clinical pictures depending on the type of affecting the eardrum-ear bones. It is a common clinical condition that we sometimes experience a discharge ear and sometimes hearing loss. Usually, it occurs when the middle ear infections that started in early childhood are not adequately treated and controlled. Those who started in early childhood are diagnosed around the age of 8-10. In simple otitis media, only the hole in the membrane and ossicular system are affected. Middle ear inflammation with cholesteatoma, along with advanced destruction in the membrane and bone chain, progresses with melting in neighboring bones. Cholesteatomas are often in the form of a cyst or pocket and are defined as the skin that develops in the wrong place in the ear. As they grow, they can cause serious problems such as hearing loss, dizziness, inflammation in the brain and facial paralysis as they cause damage to the bone tissue they are in contact with. Chronic otitis media; It can be flowing, flowing or flowing periodically. While the discharge of chronic middle ear infections can be stopped mostly with drug treatment, in chronic otitis media with cholestoma, the discharge remains unresponsive to drug treatment. In chronic chronic otitis media, ear discharge is foul-smelling.

How does chronic middle ear inflammation with cholestotoma occur?

Cholesteatoma occurs as a result of recurrent inflammatory conditions in the middle ear or when there is an inability to study the Eustachian tube. The Eustachian tube is a tube that allows air to pass through your nasal air to equalize the middle ear pressure and has the task of opening and closing between the middle ear and our mouth in certain situations. The air in the middle ear is absorbed by the body when the eustachian tube is inadequate due to allergies, colds or sinusitis, and a partial vacuum (negative pressure) occurs in the ear. Negative pressure pulls the eardrum inside, creating a pocket or pouch in the membrane (especially areas where the eardrum has weakened due to past ear infections are more susceptible to this negative pressure). Earwax slowly begins to accumulate inside this pouch or pocket. Over time, this pouch or pocket will not be able to clean itself, which will prepare the basis for the inflammation we call cholestoma. A congenital (congenital) form of cholesteatoma can also be seen in the middle ear and the surrounding head bones. However, it is the most common form accompanying ear infections mentioned above.

Causes of Cholesteatoma

In addition to repeated infections, a cholesteatoma can also be caused by the eustachian tube, a tube that runs from the back of the nose to the middle of the ear.

The Eustachian tube allows air to flow through the ear and equal ear pressure. Eustachian tube may not work properly due to any of the following:

  • Chronic ear infections
  • Sinus infections
  • Colds
  • Allergies

If your eustachian tube is not working properly, a partial vacuum may occur in your middle ear. This can cause a portion of your eardrum to be pulled into the middle ear, creating a cyst that can turn into cholesteatoma. The growth then grows larger when it is filled with old skin cells, fluids and other waste materials.

There are two reasons for cholesteatoma

1) Congenital Cholesteatoma: It is caused by misdirected epithelial residues during fetal development. It develops behind the intact eardrum and is late noticeable.

2) Acquired (Regained) Cholesteatoma: This cholesteatoma also occurs for two reasons:

      - It develops from pockets formed as a result of collapse in the eardrum,

      - If the eardrum is perforated; The outer ear canal is formed by entering the middle ear cavity through the epithelium hole or spilled epithelial residues. Sometimes, cholesteatoma may develop from the epithelium that is implanted during the surgical procedure.

Cholesteatoma Symptoms

Symptoms associated with a cholesteatoma typically begin mildly. As the cyst grows, they become more severe and cause problems in the ear.

Symptoms of cholesteatoma are:

  • Intermittent or constant ear discharge
  • The stream is smelly
  • Earache
  • Hearing loss
  • Headache
  • Numbness and numbness in the face, sometimes paralysis
  • Dizziness

Initially, a foul-smelling fluid comes from the affected ear. As the cyst grows, it will begin to create a feeling of pressure that can cause discomfort in the ear. You may also feel pain inside or behind the ear. The pressure of the growing cyst can even cause hearing loss in the affected ear.

If you experience any of these symptoms, call your doctor right away. If vertigo, facial muscle palsy, and cyst continue to grow uncontrollably, permanent hearing loss may occur.

Potential Complications of The Cholesteatoma

Because cholesteatoma destroys surrounding tissues and makes the middle ear susceptible to infection, the following complications may occur in chronic middle ear infections with cholesteatoma:

Permanent hearing loss
- Inflammation of the inner ear
- Facial paralysis
- Meningitis
Brain tissue inflammation
- Earache
- Neck vein inflammations


In general, the only way to treat a cholesteatoma is by surgical removal. Cholesteatoma sac should be removed to prevent complications. Cholesteatomas do not disappear naturally. Often they continue to grow and cause additional problems.

Is chronic otitis media with cholestotoma dangerous?

Ear cholesteatomas can be dangerous and should never be neglected. Inflammation in the bone can spread to surrounding areas, including the inner ear and the brain. If left untreated, it can lead to deafness, brain abscess, meningitis, and rarely death.

Diagnosis of The Cholesteatoma

How is chronic middle ear inflammation with cholestoma diagnosed?

The otolaryngologist and head and neck surgery specialist can determine the presence of cholesteatoma by examination. The first treatment is to carefully clean the ear, with antibiotics and ear drops. The initial treatment is aimed at cutting the ear discharge and controlling the inflammation. Hearing and balance tests may require radiological examination and computed tomography of the mastoid bone (bone behind the ear). These tests are performed to determine the level of hearing and the degree of damage due to cholesteatoma. Radiological and audiological examination is required to evaluate the size and extent of cholesteatoma. The audiological examination determines the person's hearing levels of the disease. It may be good for the patient to hear even though the ear bones are not observed with radiological imaging methods. In this case, it should be known that inflammation plays a role in the transmission of sound, just like the ear bones, and hearing can be reduced if hearing is not increased with ear prostheses in case of surgical cleansing of the inflammation.

Treatment of The Cholesteatoma

How is chronic otitis media treated with cholestotoma treated?

Chronic otitis media requires surgical treatment whether or not with cholestatoma. Surgical treatment is mostly done under general anesthesia (narcosis). The main purpose of surgery is to clear the cholesteatoma and infection and get a dry ear without infection. Hearing protection or correction is the secondary goal in treatment In cases of severe ear damage, it may not be possible to maintain the anatomical integrity of the hearing and ear. In these cases, the patient's ear can be turned into an empty cavity and the ear canal can be enlarged to see this space. These patients with an open mastoidectomy cavity must protect their ears from water for life. Rarely, facial nerve repair, brain fluid repair, or additional interventions aimed at controlling dizziness may be required. In very common inflammations, a second operation may be required after 6 - 12 months for control or when hearing is left to the next operations. The second surgery aims to correct hearing, and at the same time remove cholesteatoma residues in the middle ear and mastoid bone. In rare cases with serious infection, a long stay in the hospital may be required for antibiotic therapy. Rest period is 2-3 weeks. If cholesteatoma has damaged any bone in your ear, a second surgery is required to repair it.

After surgery, some people experience temporary dizziness or taste abnormalities. These side effects almost always go away on their own within a few days.

How to monitor chronic middle ear inflammation with cholestoma?

Due to the risk of recurrence of cholesteatoma after surgical treatment, outpatient follow-up of the patient is important and necessary. In patients with an open mastoidectomy cavity, a check should be performed every few months to prevent new infections and clean the cavity. Lifelong follow-up and examination may be necessary in some patients.

You can find details about "Smelly ear discharge - Malodorous ear discharge - Cholesteatoma - Cholesteatoma treatment - Cholesteatoma Symptoms - Cholesteatoma Definition - Mastoidectomy operation - Ear surgery in Istanbul - Ear surgery in Turkey" at >> Chronic Otitis Media - Definition, Symptoms, Complications and Treatment / Mastoidectomy Operation in Istanbul, Turkey / Bad Smell Inflammatory Ear Discharge May Be a Symptom of "Cholesteatoma"!

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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
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