What is cholesteatoma?
Cholesteatoma is an abnormal collection of skin
cells that develops inside the middle ear or mastoid bone. Although it is not a cancer, it continues to
grow over time and can progressively damage the surrounding structures of the
ear.
As the cholesteatoma enlarges, it may erode the
tiny hearing bones, affect the balance organs, and in advanced cases involve
the facial nerve or nearby structures. Because it does not disappear on its
own, timely diagnosis and surgical treatment are essential.
What
causes cholesteatoma?
Cholesteatoma may develop as a result of:
• Chronic middle ear infections.
• A long-standing perforated eardrum.
• Poor Eustachian tube function.
• Retraction of the eardrum, creating a pocket
that traps skin cells.
• Congenital cholesteatoma, which is present at
birth but may not be detected until later in childhood.
Signs
and Symptoms
Common symptoms include:
• Persistent or recurrent foul-smelling ear
discharge.
• Progressive hearing loss.
• A feeling of fullness or pressure in the ear.
• Ear pain in some patients.
• Ringing in the ears (tinnitus).
• Dizziness or balance problems.
• Weakness of the facial muscles in advanced
cases.
Symptoms usually worsen gradually as the
disease progresses.
What
happens if cholesteatoma is left untreated?
Without treatment, cholesteatoma can lead to
serious complications, including:
• Permanent hearing loss.
• Destruction of the hearing bones (ossicles).
• Mastoid bone infection (mastoiditis).
• Facial nerve injury or facial paralysis.
• Balance disorders.
• Meningitis.
• Brain abscess in rare but life-threatening
cases.
Early diagnosis greatly reduces the risk of
these complications.
How is
cholesteatoma diagnosed?
Diagnosis typically includes:
• A detailed ENT examination.
• Otoscopic or microscopic examination of the
ear.
• Hearing evaluation (Audiometry).
• High-resolution CT scan of the temporal bone
to assess the extent of disease.
• MRI in selected patients, particularly when
recurrent disease is suspected.
These investigations allow the surgeon to
determine the extent of the cholesteatoma and plan the most appropriate
treatment.
How is
cholesteatoma treated?
Unlike simple ear infections, cholesteatoma cannot be cured with medication
alone.
Surgical treatment is the standard of care and
aims to:
• Completely remove the cholesteatoma.
• Eliminate chronic infection.
• Preserve healthy ear structures whenever
possible.
• Restore or improve hearing when feasible.
• Prevent recurrence and future complications.
Surgery
and Ear Reconstruction
Depending on the severity of the disease,
surgery may include:
• Mastoidectomy
to remove the cholesteatoma and infected bone.
• Tympanoplasty
to repair the eardrum.
• Ossiculoplasty
to reconstruct damaged hearing bones.
• Combined procedures when multiple structures
require treatment.
The surgical approach is tailored to each
patient's condition to achieve complete disease removal while preserving
hearing whenever possible.
Recovery
After Surgery
Recovery depends on the extent of surgery and
the condition of the middle ear.
Patients are generally advised to:
• Keep the ear dry.
• Take prescribed medications.
• Avoid strenuous physical activity during the
initial recovery period.
• Attend regular follow-up visits.
• Undergo postoperative hearing evaluation.
Some patients may require long-term monitoring
because cholesteatoma can occasionally recur.
Why is
Early Treatment Important?
Cholesteatoma does not resolve spontaneously
and continues to enlarge over time. Delayed treatment increases the likelihood
of irreversible hearing loss, destruction of middle ear structures, and
potentially serious complications involving the facial nerve or the brain.
Early surgical intervention offers the best
opportunity to preserve hearing, eliminate disease, and achieve excellent long-term
outcomes.
A
Message to Patients
Persistent ear discharge with an unpleasant
odor, progressive hearing loss, or repeated ear infections should never be
ignored. Early evaluation by an ENT specialist allows cholesteatoma to be
diagnosed before serious complications develop, helping preserve hearing and
protect long-term ear health.
Frequently
Asked Questions
Is
cholesteatoma a type of cancer?
No. Cholesteatoma is not cancerous. However, it
is a destructive condition that requires surgical treatment because it
continues to grow and damage nearby structures.
Can
cholesteatoma be treated with antibiotics?
Antibiotics may temporarily control infection,
but they cannot remove the cholesteatoma. Surgery is the definitive treatment.
Can
cholesteatoma return after surgery?
Yes. Although surgery is highly effective,
cholesteatoma can recur in some patients. Regular follow-up examinations are
essential for early detection of recurrence.
Will
surgery improve my hearing?
The goal
of surgery is to preserve or improve hearing whenever possible. Hearing
outcomes depend on the extent of disease and the condition of the hearing bones
before surgery.