Cholesteatoma is an abnormal skin growth that develops in the middle ear, often behind the eardrum.

Although classified as a benign condition, it presents serious risks to ear health, hearing, and balance if untreated.

This growth arises from the accumulation of keratinized squamous epithelium cells, which normally belong to the outer ear canal but abnormally migrate into the middle ear space. Over time, these cells form a cyst-like mass that can erode surrounding tissues and lead to dangerous complications.

Origins and Causes

Cholesteatoma can be congenital, present at birth, or more commonly acquired over time. Acquired cholesteatomas develop mainly due to chronic middle ear infections or dysfunction of the Eustachian tube—a small canal connecting the middle ear to the back of the throat that helps equalize pressure and drain normal secretions.

When the Eustachian tube does not function correctly, negative pressure builds in the middle ear, leading to retraction pockets in the eardrum. These pockets trap dead skin cells, which then accumulate and expand into a cholesteatoma. Additionally, a persistent perforation or rupture of the eardrum can allow skin from the ear canal to grow abnormally into the middle ear cavity.

Symptoms and Signs

In early stages, cholesteatoma may remain asymptomatic or produce mild, nonspecific symptoms similar to common ear infections. As it enlarges, typical signs include:

- Persistent, foul-smelling ear discharge that may be watery or yellow-green and resists antibiotic treatment.

- A feeling of fullness or pressure in the affected ear.

- Dizziness or imbalance if the inner ear structures are compromised.

- Occasional ear pain, although this is less common than with typical infections.

Diagnosis

Diagnosing cholesteatoma requires comprehensive clinical evaluation by an ear, nose, and throat specialist. Examination typically involves otoscopy to visualize the eardrum and ear canal. Imaging techniques such as high-resolution computed tomography (CT) scans of the temporal provide detailed information about the extent and location of the growth, bones erosion, and involvement of nearby structures.

Expert ear surgeons emphasize timely diagnosis to halt disease progression. According to Dr. Neil S. Patel, a renowned otolaryngologist, "Early detection and surgical removal of cholesteatoma are crucial to preserving hearing and preventing severe complications. Delaying treatment increases the risk of irreversible damage to the ear and surrounding tissues."

Treatment Approaches

Medical therapy alone cannot cure cholesteatoma due to its destructive nature. The primary treatment is surgical removal to eradicate the abnormal skin growth, prevent recurrence, and reconstruct damaged structures when possible. Surgical techniques vary depending on the size and spread of the cholesteatoma but commonly include:

Tympanomastoidectomy: Removal of cholesteatoma from the middle ear and mastoid bones.

Ossiculoplasty: Reconstruction of the tiny bones in the middle ear to restore hearing function.

Tympanoplasty: Repairing the eardrum if it is perforated.

Complications and Prognosis

Untreated cholesteatoma poses risks of serious complications, including chronic infections, hearing loss, balance disorders, facial nerve damage, and intracranial infections. Early surgical intervention improves prognosis significantly, with many patients retaining or regaining good hearing and avoiding life-threatening sequelae.

Preventive Measures

Preventing cholesteatoma relies on effective treatment of middle ear infections and maintaining proper ear health. This includes timely management of upper respiratory tract infections, avoiding insertion of foreign objects into the ear, and monitoring children with recurrent ear infections closely.

Cholesteatoma represents a potentially dangerous ear condition characterized by abnormal skin growth in the middle ear that can progressively destroy crucial ear structures. Often caused by chronic infections or Eustachian tube dysfunction, its symptoms include persistent ear discharge, hearing loss, and dizziness. Prompt action is vital to prevent severe complications and preserve auditory function.