Cholesteatoma, or epitympanic otitis media, is a chronic suppurative inflammation of the middle ear caused by the collection of cornified squamous epithelium (a type of tissue) from the ear canal. Only surgery can lead to complete healing of this benign tumor. However, in a small number of patients, surgery is not possible. If so, the situation can be improved by using custom hearing aids.
Cholesteatoma can have several causes, including prolonged otitis media or a hole in the eardrum, through which the squamous epithelium enters the middle ear where it can trigger an inflammatory reaction. This subsequently leads to the destruction of the bone in the area of the tympanic cavity and the petrous bone in the middle or inner ear. Depending on its onset, a basic distinction is made between three different forms of cholesteatoma:
In the initial phase, cholesteatoma often goes unnoticed and the first symptoms are similar to those of a common otitis media. Typical signs are ear pain, pressure, or otorrhea, in which foul-smelling liquids leak out of the ear. Affected individuals also notice a reduction in hearing capacity from the diseased ear. If the disorder is left untreated, hearing damage and even hearing loss can occur. According to the cases, the disorder is also accompanied by nystagmus, dizziness, nausea and vomiting. The facial nerve, brain, and meninges may also be involved at an advanced stage. Facial paresis, fever, stiff neck, severe headaches, spasms or fainting also occur. Fortunately, however, early medical treatment can prevent these symptoms.
To determine if a patient is suffering from cholesteatoma, the ENT doctor uses an otomicroscopy and an otoscope to perform hearing, balance, neurological and bacteriological examinations. Computed tomography is a fundamental element in the diagnostic procedure. Through a CT scan, your doctor will be able to accurately assess the situation and ascertain the size of the tumor to determine the next steps.
The best approach for treating cholesteatoma is surgery, where different procedures are used depending on the specific diagnosis. In the context of cholesteatoma surgery, the surgeon can, for example, close the eardrum or rebuild the damaged ossicular chain to restore or optimize acoustic transmission.
The exact procedure and the subsequent healing period vary from case to case. Cholesteatoma surgery usually takes three to four hours and is performed in the hospital under general anesthesia. The long duration of this relatively minor surgery depends on the complexity of the ear structures and the necessary attention that surgeons must pay. This is followed by a hospital stay of at least two days and a rest period at home of several days. You can clarify these details directly with your ENT doctor.
Like any surgery, cholesteatoma-related interventions can also carry risks. For example, complications such as ringing in the ears, otorrhea, major scarring, altered taste, hearing loss or facial nerve paralysis can arise. However, these problems occur in very rare cases.
The prognosis following cholesteatoma surgery is extremely favorable if performed early. In most cases, the tumor can be completely removed without complications, and hearing improves markedly immediately after surgery. Some patients may experience recurrent infections and new cholesteatoma formations. In these cases it is necessary to intervene again surgically.
In most cases it is possible to treat cholesteatoma without resorting to surgery. Complete healing can only be achieved if all foci of inflammation are completely removed. Although doctors use antibiotics to prepare for surgery, they serve merely to stem inflammation and minimize the risk of complications from the operation. In some patients, middle ear reconstruction is no longer possible. In this case, a customized hearing aid is used with which it is possible to restore or improve hearing performance. You can discuss your options with your ENT doctor or Amplifon hearing care professional.