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Cholesteatoma

What is it?

Cholesteatoma is a disease of the middle ear, which causes painless ear discharge and gradual hearing loss, as well as dizziness, tinnitus, loss of taste sensation and rarely, facial palsy, complete loss of hearing, meningitis and brain abscess. This disease can occur at any age and can be particularly aggressive in young children. The ear discharge is particularly smelly. It can occur in both ears, but usually occurs in only one. Sometimes patients have no discharge at all, but the hearing steadily gets worse.

What causes it?

There are two theories on the cause of cholesteatoma disease:

Skin Migration

Although the skin of the external ear looks like any other, it behaves differently. As the skin grows it migrates down the ear canal, thus keeping the ear clean. In cholesteatoma the skin migrates in through the eardrum causing a ball of skin, which is prone to infection and discharge.

Middle Ear Infection

Some patients have many ear infections and this damages the eardrum making it thin and collapsible. It also damages the middle ear and tube to the nose, which helps the ears to pop. When the ear becomes very collapsible it can form a pocket, which collects skin.

The ball of skin continues to enlarge eating away at the surrounding bone of the skull including the delicate bones in the middle ear and inner ear. This causes the problems mentioned above.

What can be done?

A cholesteatoma needs to be removed to prevent it destroying the ear, causing further discharge and deafness. The operation is called a mastoidectomy. The patient is asleep (general anaesthetic). The surgeon usually attempts to remove the cholesteatoma completely and then graft the hole in the eardrum that is left. If possible the surgeon also tries to repair the three small bones in the middle ear, which have usually been damaged by the cholesteatoma.

After the operation the patient is left with a small scar either in front or behind the ear. The graft to create the new eardrum is supported with a ribbon soaked in antiseptic. This is removed from the ear about four weeks after the operation.

What can go wrong?

The complications of a mastoid operation are similar to having a cholesteatoma but much less common. Discharge from the ear can occur if the graft fails to repair the eardrum completely. Hearing loss can occur if the repair to the middle ear bones fails. Dizziness, tinnitus, facial palsy and CSF leak are all very rare complications due to damage with the surgical drill.


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