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Ear cholesteatoma

A chronic purulent inflammation of the middle ear

About otitis media epitympanalis

This article covers the key aspects of cholesteatoma, including its symptoms, causes, and treatment options. If you want to obtain additional information about the hearing impairment linked to epithympanic otitis media, you can schedule a complimentary consultation with an Amplifon hearing specialist.

What is cholesteatoma?

Cholesteatoma, also known as pearl tumor or epithympanic otitis media, refers to the growth of keratinising squamous epithelium in the middle ear.

Cholesteatoma can develop into a chronic middle ear inflammation called chronic bone suppuration, which can cause hearing impairment by affecting the ossicles and surrounding skull bone. Medical professionals consider cholesteatoma in the ear to be a benign tumor with a high likelihood of successful treatment.

There is no definitive answer to the question of how fast a cholesteatoma in the middle ear grows.

However, as a general rule, the earlier the condition is diagnosed and treated or operated on, the better the outcome. While cholesteatomas can occur at any age, they are more common in children.

Cholesteatoma symptoms

During the early stages of cholesteatoma, symptoms may not be noticeable. 

However, initial symptoms are akin to those of a standard chronic middle ear infection, such as ear pressure, pain, and otorrhea (discharge of an unpleasant-smelling fluid from the ear). Moreover, the ear's hearing and balance system may also be affected.

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Cholesteatoma causes

When we examine a healthy ear, we observe that the keratinising squamous epithelium in the outer ear canal and the mucous membrane in the middle ear are entirely separate from each other.

However, there are several reasons why this barrier can be breached. Factors that could potentially trigger cholesteatoma include persistent negative pressure in the middle ear, such as in the case of a prolonged middle ear infection, or a rupture or perforation in the eardrum. When this happens, squamous epithelium may grow in the middle ear cavity, spread, and cause inflammation.

Cholesteatoma effects

Cholesteatoma can result in hearing impairment ranging from mild to severe, as well as additional symptoms such as eye tremors (nystagmus), dizziness, nausea, and vomiting. If left untreated, it can progress to affect the facial nerve, meninges, and brain. This can result in severe consequences, such as facial paralysis, fever, stiff neck, severe headaches, impaired consciousness, and convulsions. However, effective treatments are available to prevent these outcomes.

If you are interested in learning more about the hearing loss that accompanies this condition and its treatment options, visit an Amplifon store near you for a complimentary consultation.

Cholesteatoma treatment options

The primary treatment for cholesteatoma involves surgical intervention, with the CT scan serving as a crucial diagnostic tool. If the condition has resulted in hearing loss, hearing aids can be used as a potential solution. Further details can be obtained through a complimentary consultation.

Diagnosis by an ENT specialist

To establish a foundation for treatment, the ENT specialist conducts a comprehensive evaluation, which includes an ear microscopy, ear mirrors, hearing and balance assessments, as well as bacteriological and neurological exams. A crucial aspect of the diagnosis is the use of computed tomography, which enables the physician to identify the location and size of the cholesteatoma in order to determine the appropriate course of action.

Can an operation be avoided?

It generally not possible to treat cholesteatoma without surgery. However, prior to surgery, an ENT specialist may prescribe antibiotics (such as ear drops or tablets) to eliminate bacteria and decrease inflammation. This medication can also lower the risk of surgical complications. It is important to note that the prognosis for cholesteatoma treatment is generally favorable.

Cholesteatoma surgery in detail

Cholesteatoma surgery often involves multiple techniques, such as repairing a perforated eardrum or reconstructing a damaged ossicular chain to improve sound transmission. The duration of recovery following the operation varies for each patient and cannot be generalised.

Since the recovery period can differ depending on the individual case, the same is true for the duration of cholesteatoma surgery. Typically, the procedure takes place in a hospital under general anesthesia and lasts for roughly 3 to 4 hours. This highlights the meticulous approach of the specialists, who handle delicate ear structures with utmost care. Afterwards,  there is a period of recuperation and most patients are required to stay at the hospital for a few days following the procedure. It is recommended to consult with an ENT specialist for further information.

Like any other surgical procedure, cholesteatoma surgery entails certain risks. Potential complications may include ear drainage, tinnitus, altered taste, extensive scarring, hearing impairment, or facial nerve palsy. Nonetheless, the prognosis is generally positive. In the majority of cases, the cholesteatoma can be entirely removed without complications, and hearing typically improves immediately following the operation.

In rare cases, some patients may not be eligible for middle ear reconstruction. In these situations, a tailored hearing aid can enhance or restore hearing ability. Your Amplifon hearing care expert can offer guidance on this matter.

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