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Diseases of the Ear - Cholesteatoma

Cholesteatoma

A cholesteatoma occurs if skin from the inner side of the tympanic membrane sloughs off and mixes with ear wax that penetrates the open hole in the eardrum to the middle ear chamber and fails to drain through the Eustachian tube. Over time the accumulation of dead skin and wax causes a cyst-like mass to grow. This is known as a cholesteatoma. If left untreated and the mass becomes larger, the mass can put pressure to nearby parts of the ear causing serious damage such as the eardrum and ossicles. In serious cases, cholesteatomas have been known to penetrate into the mastoid area causing infection or into the cranial chamber (brain) causing meningitis (infection of the covering of the brain - menges).  

Cholesteatoma Symptoms

The attico-antral form of the condition initially causes a smelly discharge to leak from the ear. You may also have a hearing loss and sometimes tinnitus. You can get vertigo - dizziness - if the semicircular canals, which form part of the balance system, are also affected.

Signs that damage is taking place include

  • extreme pain, especially in the side of the head where the problem is
  • continual vertigo and nausea
  • loss of hearing
  • a gradual weakening of the facial muscles causing a droopy look on one side as if recovering from a stroke
  • headaches similar to migraines

Treatment for a Cholesteatoma

It is important to remove the cholesteatoma and all traces of infection. For this, it is usually necessary to have a surgical procedure known as mastoid surgery. If your ENT (Ear nose and throat specialist) is not a surgeon, he/she may refer you to an otolaryngologist (head and neck surgeon) or the surgery. The surgeon gains entrance to the middle ear chamber by making an incision behind the ear and through the mastoid bony tissue. Once the middle ear chamber is opened, the mass is removed and the surgeon will check to make sure the ossicles are not damaged and that the cholesteatoma has not penetrated to other areas of the cranium.

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