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What Are the Causes and Symptoms of Cholesteatoma?

Cholesteatoma

What Is Cholesteatoma?

Cholesteatoma is an abnormal skin growth or skin cyst in the middle ear or mastoid, which is behind the eardrum. It is noncancerous but it is dangerous and should never be ignored. It can erode the bone which can cause infection to spread into the inner ear and brain. Seek out cholesteatoma treatment to prevent severe complications from untreated cholesteatomas such as facial muscle paralysis, deafness, brain abscess and meningitis. Due to the fact that it does not contain cholesterol or lipids and is noncancerous, “cholesteatoma” is a misnomer. Perhaps “keratoma” may be more appropriate since it is a keratinised skin collection.

What Are The Causes Of Cholesteatoma?

Cholesteatoma is classified into primary and secondary. Primary cholesteatoma occurs mainly due to the dysfunction of the Eustachian tube. The Eustachian tube functions to ventilate the middle ear space, ensuring equal pressures behind and in front of the eardrum. When it malfunctions, the prolonged negative pressure in the middle ear causes the eardrum to retract inwardly. As a result, the retraction pocket becomes trapped behind the eardrum. Over time, the collection of skin and poor middle ear ventilation results in recurrent infection, inflammation, pus discharge and ultimately eardrum perforation. As it grows in size, it further damages the eardrum and develops ear polyps or tissue in the middle ear or mastoid air cell tracts.

Secondary cholesteatoma occurs after an eardrum is perforated. Consequently, skin cells outside of the eardrum migrate through the hole and enter the middle ear space. Gradually, ear wax and skin builds up in the middle ear and forms a cholesteatoma. Another cause of secondary cholesteatoma is by surgery that unintentionally implants skin cells in the middle ear space, such as a tympanoplasty surgery.

Regardless of primary or secondary, cholesteatoma eventually causes bone erosion in the middle ear and consequent hearing loss. The bone is eroded by the pressure exerted from the expansion of the growth, and also by the enzymatic breakdown of acid protease, acid phosphatase and collagenase produced by cholesteatoma. Moreover, persistent bacterial infection further causes inflammation and bone destruction.

What Are The Symptoms Of Cholesteatoma?

Common symptoms of cholesteatoma include hearing loss, ear discharge (otorrhea), ear pain, dizziness, sensation of ear fullness, recurrent ear infections and possible facial muscle weakness on the affected side. Hearing loss is evident early in secondary cholesteatoma when the eardrum is perforated since the normal mechanism of hearing is compromised. However, hearing loss may present late in primary cholesteatoma. Interestingly, there have been cases that patients are completely asymptomatic. If you present with any of the symptoms, do not hesitate to visit a doctor, otolaryngologist or ENT (Ear Nose Throat) specialist. A careful ear examination should be able to establish the diagnosis, with evidence of either a retracted or perforated eardrum.

What Are The Treatments?

In the presence of ear infection with discharge (chronic suppurative otitis media), topical antibiotics drops are the first line of treatment, such as ciprofloxacin or ofloxacin. Use the drops twice daily for two weeks to clear the infection. While putting the drops, it is recommended to lie down with the affected ear facing up. Additionally, aural toileting may help to maintain ear hygiene by cleaning up discharge and irrigating with saline solution. It is important to ensure any solution or drops entering the ear to be in near body temperature as cold substance can cause vertigo or dizziness.

Cholesteatoma removal requires surgical treatment as the growth does not resolve on its own. Usually, this is done together with eardrum repair and mastoidectomy (removal of mastoid bones) if the mastoid air cells have been badly affected.

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