What is cholesteatoma?

A cholesteatoma is an abnormal growth of skin in the middle ear behind the eardrum that usually develops as cysts or pockets that flake off layers of old skin. Over time it can grow and destroy nearby middle ear bones or other ear structures. It is also a disorder that destroys a part of the mucous membrane of the middle ear that becomes epithelial tissue. This disease generates dead epithelial cells that when they come in contact with the mucosa in which it is located, they easily become infected. This condition grows as time goes by. They can be of various types:

Over time it can grow and destroy nearby middle ear bones or other ear structures.

  • Congenital: it is born with it, it is rare.
  • Acquired: appears after birth, usually due to chronic diseases of the middle ear. Within this type, there are two subtypes:
    • Primary: it is formed when there is a chronic alteration in the Eustachian tube, which generates negative pressures in the middle ear. There, retraction pockets are formed, where the desquamated cells are trapped and may affect the ossicles chain and the temporal bone. It is the most frequent.
    • Secondary: occurs when the desquamated cells pass from the external ear to the middle ear through perforations in the eardrum, where they accumulate and form the cholesteatoma.

What are the symptoms of cholesteatoma?

Some symptoms that may result from such a growth may be:

  • Hearing loss
  • Loss of balance
  • Dizziness
  • Paralysis
  • Dysfunction of facial muscles

What are the causes of cholesteatoma?

Although they can be congenital (appearing at birth), they occur more commonly if there are successive or chronic ear infections. The functioning Eustachian tube compensates for pressure in the middle ear, but when it is not working properly, negative pressure can build up and push part of the tympanic membrane into the middle ear. This creates a sac or cyst with old skin and other debris: the cholesteatoma. The cyst may grow or become infected and cause the middle ear bones or different structures of the ear to rupture. This damage could affect hearing, balance and possibly facial muscle function.

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Thus, the main risk factors are:

  • History of recurrent otitis media
  • Craniofacial malformations
  • Family history of middle ear pathologies
  • Down syndrome
  • Turner syndrome
  • Cleft palate

What is the treatment of cholesteatoma?

It usually has to be removed by surgery, which is usually successful, although it has to be checked periodically and the ear has to be cleaned by the specialist. In addition, the cholesteatoma may reappear and another surgery may be necessary.

How is cholesteatoma diagnosed?

An ear examination can diagnose a sac or opening, also called a perforation, in the eardrum, with constant discharge. The storage of old skin cells can be seen with a microscope or an otoscope, special instruments used to examine the ear. Occasionally a cluster of blood vessels may be seen in the ear. These tests may be done to rule out other causes of vertigo, such as:

  • CT scan
  • Electronystagmography

What specialist treats it?

Cholesteatoma is a pathology that is treated by the otolaryngologist. At Top Doctors we offer each patient the best specialist depending on their location and pathology.