Cholesteatoma: Causes, Symptoms, and Diagnosis
A cholesteatoma is an abnormal, noncancerous skin growth that can develop in the middle section of your ear, behind the eardrum. It may be a birth defect, but it’s most commonly caused by repeated middle ear infections.
A cholesteatoma often develops as a cyst, or sac, that sheds layers of old skin. As these dead skin cells accumulate, the growth can increase in size and destroy the delicate bones of the middle ear. This may affect hearing, balance, and the function of facial muscles.
What causes a cholesteatoma?
Besides repeated infections, a cholesteatoma may also be caused by a poorly functioning eustachian tube, which is the tube that leads from the back of the nose to the middle of the ear.
The eustachian tube allows air to flow through the ear and equalize ear pressure. It may not work properly due to any of the following:
- chronic ear infections
- sinus infections
If your eustachian tube isn’t working correctly, a partial vacuum might occur in your middle ear. This may cause a section of your eardrum to be pulled into the middle ear, creating a cyst that can turn into a cholesteatoma. The growth then becomes larger as it fills with old skin cells, fluids, and other waste materials.
Cholesteatoma in children
In very rare cases, a baby may be born with a cholesteatoma. This is considered a birth defect. Congenital cholesteatomas can form in the middle ear or in other areas of the ear.
In cases where children acquire ear infections repeatedly early in life, it is possible that cholesteatomas can develop from a young age.
What are the symptoms of a cholesteatoma?
The symptoms associated with a cholesteatoma typically start out mildly. They become more severe as the cyst grows larger and begins to cause problems within your ear.
Initially, the affected ear may drain a foul-smelling fluid. As the cyst grows, it will begin to create a sense of pressure in your ear, which may cause some discomfort. You might also feel an aching pain in or behind your ear. The pressure of the growing cyst may even cause hearing loss in the affected ear.
Call your doctor right away if you’re having any of these symptoms. Vertigo, facial muscle paralysis, and permanent hearing loss can occur if the cyst continues to grow unchecked.
What are the potential complications of a cholesteatoma?
When left untreated, a cholesteatoma will grow larger and cause complications that range from mild to very severe.
The dead skin cells that accumulate in the ear provide an ideal environment for bacteria and fungus to thrive. This means the cyst can become infected, causing inflammation and continual ear drainage.
Over time, a cholesteatoma may also destroy the surrounding bone. It can damage the eardrum, the bones inside the ear, the bones near the brain, and the nerves of the face. Permanent hearing loss may occur if the bones within the ear are broken.
The cyst may even spread into the face if it continues to grow, causing facial weakness.
Other potential complications include:
- chronic infection of the ear
- swelling of the inner ear
- paralysis of the facial muscles
- meningitis, which is a life-threatening brain infection
- brain abscesses, or collections of pus in the brain
How is a cholesteatoma diagnosed?
To determine whether you have a cholesteatoma, your doctor will examine the inside of your ear using an otoscope. This medical device allows your doctor to see if there are signs of a growing cyst. Specifically, they will look for a visible deposit of skin cells or a large mass of blood vessels in the ear.
Your doctor may need to order a CT scan if there are no obvious signs of a cholesteatoma. A CT scan might also be ordered if you’re showing certain symptoms, such as dizziness and facial muscle weakness. A CT scan is a painless imaging test that captures images from a cross-section of your body. The scan allows your doctor to see inside your ear and skull. This can help them better visualize the cyst or rule out other possible causes of your symptoms.
How is cholesteatoma treated?
Generally speaking, the only way to treat a cholesteatoma is to have it surgically removed. The cyst must be removed to prevent the complications that can occur if it grows larger. Cholesteatomas don’t go away naturally. They usually continue to grow and cause additional problems.
Once a cholesteatoma has been diagnosed, a regimen of antibiotics, ear drops, and careful cleaning of the ear will most likely be prescribed to treat the infected cyst, reduce inflammation, and drain the ear. Your medical professional will then be able to better analyze the growth traits of the cyst and make a plan for surgical removal.
In most cases, surgery is an outpatient procedure. This means that you don’t have to stay in the hospital after the procedure. A hospital stay is only necessary if the cyst is very large or if you have a serious infection. The surgery is done under general anesthesia. After the initial surgery to remove the cyst, follow-up surgery to reconstruct any damaged portions of the inner ear and make sure that the cyst has been completely removed is often necessary.
Once the cholesteatoma is removed, you’ll need to attend follow-up appointments to evaluate results and ensure the cyst hasn’t come back. If the cyst broke any bones in your ear, you’ll need a second surgery to repair them.
After surgery, some people experience temporary dizziness or taste abnormalities. These side effects almost always resolve themselves within a few days.
Tips to prevent cholesteatomas
Congenital cholesteatomas cannot be prevented, but parents should be aware of the condition so it can be quickly identified and treated when present.
You can prevent cholesteatomas later in life by treating ear infections quickly and thoroughly. However, cysts may still occur. It’s important to treat cholesteatomas as early as possible to prevent complications. Call your doctor right away if you believe you have a cholesteatoma.
The long-term outlook for people with a cholesteatoma
The long-term outlook for people with cholesteatomas is generally good. Complications are usually rare if the cyst is caught and removed early. If a cholesteatoma sac has become particularly large or complex before it is identified, it is possible that there will be some permanent hearing loss. Imbalance and vertigo can also result from a large cholesteatoma eating through the sensitive nerves and delicate bones in the ear.
Even if it does increase in size, the cyst can almost always be removed successfully with surgery.
What are some of the risk factors of cholesteatoma?