Cholesteatoma is a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process.
Signs and symptoms
The patient may have a recurrent ear discharge. Granulation tissue and a discharge (through a marginal perforation of the ear drum) may be seen on examination. A cholesteatoma cyst consists of desquamating (peeling) layers of scaly or keratinised (horny) layers of epithelium, which may also contain cholesterol crystals. Often the debris is infected with Pseudomonas aeruginosa.
If untreated, a cholesteatoma can eat into the three small bones located in the middle ear (the malleus, incus and stapes, collectively called ossicles), which can result in nerve deterioration, deafness, imbalance and vertigo. It can also affect and erode, through the enzymes it produces, the thin bone structure that isolates the top of the ear from the brain, as well as lay the covering of the brain open to infection with serious complications.
A history of ear infection or flooding of the ear during swimming should be taken seriously and investigated as cholesteatoma should be considered a possible outcome.
Common symptoms of cholesteatoma may include: Hearing loss, mucopurulent discharge from the ear (usually brown/yellow) with a strong odor, bleeding from the ear, dizziness, vertigo, balance disruption, ear ache, headaches or tinnitus. There can also be facial nerve weakness.
There are two types: congenital and acquired. Acquired cholesteatomas, which are more common, can be caused by a tear or retraction of the ear drum.
Cholesteatoma is an epidermoid cyst of the middle ear and/or mastoid. It developed as a consequence of eustachian tube dysfunction and chronic otitis media, secondary to retraction of squameous elements of the tympanic membrane into the middle ear space. Those squamous elements cause bone destruction secondary to its expanding nature and through enzymatic destruction.
Less commonly the disease may be congenital, when it grows from birth behind the eardrum. Congenital cholesteatomas are more often found in the anterior aspect of the ear drum, in contrast to acquired cholesteatomas that usually arise from the pars flaccida region of the ear drum in the posterior-superior aspect of the ear drum.
Surgery is performed to remove the sac of squamous debris and a mastoidectomy is performed. Cholesteatomas of the middle ear may be congenital and in some cases can be removed through the ear canal. The majority of cholesteatomas require that an incision be made behind the ear to expose the affected area adequately.