Cholesteatoma is popularly known as cyst in the middle ear which is non-cancerous in nature. It might be a birth defect but most of the times it is the result of chronic ear infection. In this disease a cyst like growth occurs in the middle ear mainly due to malfunctioning of Eustachian tube and vacuum effect which pulls the eardrum towards in. In the normal ear the drum is lined with a layer of skin from where the skin cells shed normally and come out of the ear canal in the form of wax. But when skin forms a pocket, dead cells start accumulating and forms a cyst. This accumulated skin cyst, if left untreated, can damage all the tree ear bones, brain and facial nerves too.
How Cholesteatoma can be detected?
However Cholesteatoma is not easy to detect without proper examination of ear but if you experience hearing loss you must refer an ENT specialist. Patients with this disease will show recurrent ear discharge. Hearing problems occur when sound waves are hindered and are not able to pass some of the additional symptoms are:
- Foul smelling discharge from the ear canal.
- Pain behind the ear
- High pressure inside the ear
The condition effects facial and brain nerves because if the erosion is allowed to persist it can reach mastoid bone and can damage the brain partially.
What are the causes of Cholesteatoma?
As mentioned above this disease is caused due to malfunctioning of Eustachian tube of the ear. Due to which a negative pressure develops in the middle ear, which pulls the ear inside creating socket. Outer skin cells of the inner ear drum keep on shedding and start collecting in that socket. These cells later on form a cyst. If this cyst is not treated on time it can become infectious and begets Cholesteatoma.
Cholesteatoma is of two types:
- Chronic Cholesteatoma: This occurs in adults due to the blockage of Eustachian tube, a tube that connects middle ear of the nose and back of the throat. It is due to this blockage that the ear drum is pulled inwards creating vacuum and thus forming a pocket. The dead cells accumulate in this pocket and form a cyst. So this type of cholesteatoma is due to infection in the Eustachian tube.
- Congenital Cholesteatoma: This is a kind of ear disease that occurs by birth. This is thought to occur due to growth of skin cells in the wrong place in ears. Thus developing into cholesteatoma.
What if, the disease is left untreated for a long time?
If the disease is left untreated for a very long time, it can cause life threatening complications. Complications like:
- Destruction of all the ear bones that can cause deafness for the rest of the life.
- It can cause paralysis of nearby facial bones.
- It can spread to the brain nerves as well and can damage the skull muscles too which often leads to meningitis.
How Cholesteatoma is can be treated?
Non surgical methods: If cholesteatoma is at the initial stage and has not causde much of damage t the ear, then it can be treated without using surgical methods. You can go to doctor’s office to clear all the wax and dead cells. If pain persists then doctors prescribe medicines which can reduce the ailment considerably.
Surgical methods: To remove the cyst and prevent further damage to ear cholesteatoma can only be treated with surgical method. There are no other methods to remove this disease permanently. Doctors stress on removing the cyst by preserving all the essential parts of the ear. There are many surgical approaches developed so far to treat this disease:
- Mastoidectomy: In this surgical approach doctors treat the mastoid cavity and sometimes some of its parts have to be removed. Mastoid cavity is located behind the ear and is connected to the middle ear. The cyst which is formed due to malfunctioning of Eustachian tube is dragged back through the middle ear and placed in the mastoid tube. In this surgical procedure cholesteatoma is removed by drilling away the cells from the bone of mastoid cavity.
- Tympanoplasty: This involves surgery of the tympanum and two or more ear bones are removed from the ear. These ear bones are then replaced by an artificial device known as prosthesis. The two most commonly used prosthesis are Total ossicular prosthesis and partial ossicular prosthesis. At times there is extensive disease in the middle ear and it is required to put piece of plastic in the middle ear after the disease if removed.
- Tympanomastoidectomy: This is performed if the cholesteatoma has entered the last stage. In this the tympanum has to be removed altogether and a part of mastoid bone also needs to be removed. This is known as the most successful method so far, to remove the cholesteatoma completely.
Most of the times all the above mentioned surgical methods work well but there are rare cases when graft rejections occur. And these graft rejections can cause serious reactions. However this happens very rare but one might suffer a hearing loss after this. There might be a need to perform the operation twice but this can cause further complications. At times the surgery, if not carried out with proper care, can cause partial hearing loss, facial paralysis and difficulties in coordination. These disorders are generally temporary and can be reversed with the help of oral medications but if the problem persists for long then it could be something more serious. This is why patents treated with this surgery are kept under medical supervision for at least 6 months after the surgery. And doctors recommend that one should get it checked that if his skin is compatible with the surgical procedures or not because if not then such procedures should be avoided. As they can cause graft rejection reactions which are harmful for the patient.