A cholesteatoma is a purulent inflammation of the middle ear in the area behind the eardrum.
It is usually triggered by skin layers of the eardrum or the ear canal when these become lodged in the middle ear and grow in there. This results in inflammation. This is also known as a pearl tumor .
A distinction is made between several forms of these tumors.
Primary cholesteatoma
The primary variant is the congenital form or predisposition to this inflammation.
It is assumed that this form has already developed in the embryonic period despite an intact eardrum. The cause is scattered epithelia in the middle ear.
Secondary cholesteatoma
Disturbances in ventilation via the middle ear trumpet can cause increased negative pressure in the middle ear. As a result, the eardrum can retract. These retracted eardrum layers continue to grow in the middle ear and then cause inflammation.
Even if there is a hole in the eardrum, layers of skin can penetrate into the middle ear and lead to a cholesteatoma.
Traumatic cholesteatoma
Accidents that lead to bone fractures in the skull or temporal bone can also cause layers of skin to enter the middle ear. This leads to this form of cholesteatoma.
Illustration of the middle ear and the cholesteatoma (mass between the eardrum and the cochlea) © Anna | AdobeStock
At the beginning of the disease, there may not be any major symptoms.
Subsequently, however, considerable pain occurs. In addition, a strong-smelling secretion often runs out of the ear. The strength of hearing in the affected ear can also change negatively.
The ear also serves as the human organ of balance. As the disease progresses, there may also be problems with maintaining balance.
If left untreated, the inflammation can also spread to the facial nerves or the brain in extreme cases.
As the disease progresses, the bone substance can also be affected. This can damage the nerves to such an extent that facial nerve palsy (facial paralysis ) occurs.
General symptoms are also possible, including
Important: These symptoms do not necessarily all have to occur. They can be accompanied by individual symptoms or several at once.
As this is quite a diverse range of symptoms, here is an overview:
- Earache
- Strong-smelling discharge of secretions
- Reduction in hearing ability
- Dizziness, possibly with vomiting
- Facial paralysis
- Headache
- fever
- Stiff neck
The ear, nose and throat specialist is the first point of contact for ear complaints.
Among other things, he or she will examine the eardrum with a microscope and also assess your hearing using various hearing tests.
If there is an inflammation, it often reveals impaired sound conduction. In this case, we speak of conductive hearing loss.
Further examinations that are carried out if a cholesteatoma is suspected include
- Imaging procedures(CT),
- balance tests and
- bacteriological examinations (with a smear).
The only effective method is surgery (tympanoplasty). The aim is to remove the focus of inflammation and, if necessary, to restore structures of the ear that have been damaged by the inflammation. The latter is particularly indicated if hearing has already suffered as a result of the disease.
However, it may not be possible to completely remove all parts of the cholesteatoma during such an operation. If this is the case, a second operation must be performed a few months later .
The surgical method has another benefit: If the disease is based on damage to the eardrum - for example a hole - then this can also be closed and the ossicular chain rebuilt.
There is no real alternative to surgery, as this inflammation does not heal on its own. If it is not treated, the consequences can be life-threatening in some cases.
Medication is also given in addition to surgery. In most cases, these are antibiotics, which primarily also combat the inflammation. However, these drugs can also be administered before the actual procedure. This has the positive effect that the risks during surgery can be reduced due to the inflammation that has already been combated.
If the condition is recognized and treated in good time, the prognosis is good.
However, surgery only removes the symptom, i.e. the cholesteatoma. However, the actual cause often remains. There is therefore a risk that the inflammation will recur (recurrence), particularly in children with very dispersed epithelial islands.
The prognosis with regard to hearing is very individual. In some patients, hearing can be fully restored.
At an advanced stage of the disease, some damage may remain.
