What is Cholesteatoma: Cause, Symptoms and Treatment

A cholesteatoma is a noncancerous accumulation of skin cells in the middle ear, situated just behind the eardrum. It can be present at birth or develop due to ongoing ear infections that lead to the eardrum retracting or rupturing. This condition arises when dead skin cells accumulate, often resembling a pearl-like cyst. Common symptoms include a persistent foul-smelling discharge from the ear, hearing loss, and dizziness. In more severe instances, it can affect balance and the function of the facial nerve.

Symptoms

The symptoms of cholesteatoma can differ based on whether it is congenital (present at birth) or acquired later in life. Congenital cholesteatomas may not show any symptoms until they grow larger and are often discovered during routine checkups. However, both types can have the following symptoms:

• Foul-smelling ear discharge
• A sensation of pressure in the ear
• Dizziness and recurrent infections.

In more severe cases, the cyst may result in hearing loss, tinnitus, or even severe pain in or behind the ear.

As the condition progresses, symptoms can worsen, potentially leading to serious complications like vertigo, facial muscle paralysis, and permanent hearing loss if left untreated. Early warning signs, such as chronic ear discharge or pain, should prompt immediate medical attention to prevent the cyst from causing lasting damage.

Causes

Cholesteatoma is frequently caused by a retracted eardrum, which happens when there’s an imbalance in air pressure inside and outside the ear, pulling the eardrum inward. This creates a pocket or cyst that can accumulate dead skin cells and other waste materials. The Eustachian tube is responsible for balancing pressure, but when it malfunctions, it can lead to cholesteatoma. Dysfunction of the eustachian tube can arise from chronic ear infections, sinus infections, colds, or allergies, leading to negative pressure and the development of a cholesteatoma.

Although cholesteatomas can be congenital (present from birth), they are more often linked to chronic ear infections or eardrum perforations. If left untreated, the cyst can enlarge, become infected, and damage nearby structures, including the bones of the middle ear, which can impact hearing, balance, and even facial muscle function. Timely intervention is vital to prevent such complications.

Diagnosing Cholesteatoma

To determine if you have a cholesteatoma, your doctor will conduct an ear examination using an otoscope. This device enables them to inspect the inside of the ear for signs of a growing cyst. They will specifically look for skin cell deposits or an abnormal mass of blood vessels.

If no clear signs of cholesteatoma are visible, your doctor may recommend a CT scan. This imaging test is often suggested if you experience symptoms such as dizziness or facial muscle weakness. A CT scan, which is a painless procedure, captures detailed cross-sectional images of your ear and skull. It helps your doctor visualize the cyst more clearly or rule out other potential causes of your symptoms.

Treatment

If left untreated, cholesteatomas typically continue to grow and do not go away on their own. To prevent further damage to the ear and surrounding structures, the main treatment is surgical excision of the cyst. To cure infections and reduce inflammation, ear drops, antibiotics, and expert ear cleaning may be used before surgery. Complete removal of the cyst is the aim of surgery, which is usually done as an outpatient procedure under general anesthesia. In certain cases, further surgery is required to ensure complete removal or restore damaged ear structures.

Follow-up sessions following surgery are critical for assessing recovery and monitoring for recurrence. If the bones of the ear are injured, a second reconstructive treatment may be required. Although transitory side effects, such as lightheadedness or taste alterations, are possible, they often resolve within a few days. Cholesteatomas can be successfully treated with surgical techniques such as mastoidectomy and tympanoplasty, which have a high success rate and significantly improve outcomes.

Although it is impossible to avoid congenital cholesteatomas, early detection and treatment are critical. To reduce the risk of developing cholesteatomas, protect your ears from injuries or infections that can injure the eardrum, and seek treatment for persistent or recurring ear infections as soon as possible. Early medical intervention can help avert complications if a cholesteatoma develops.

Cholesteatoma is a severe but manageable condition that requires an early diagnosis and management to minimize repercussions. Early medical care is essential to maintaining your hearing and overall ear health, regardless of whether the condition is inherited or acquired. See a doctor immediately if you have hearing loss, recurrent ear infections, or other unusual ear issues. The majority of people may successfully manage and recover from this illness with timely treatment.

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