Chondroma tumors symptoms & treatment

Cholesteatomas, also called cholesterol granulomas, affect the ears. They’re noncancerous, skin-lined cysts that develop behind the eardrum in the middle ear. They can develop when dead skin cells become trapped deep inside the ear. In rare cases, people are born with them. Just nine out of every 100,000 people in the U.S. are diagnosed with a cholesteatoma each year.

Usually starting as a small cyst, cholesteatomas may become larger over time. If you keep having ear drainage or ear infections that don't improve with medication and treatment, see your doctor. Early detection and treatment for a cholesteatoma can help prevent hearing loss and other complications.

Cholesteatoma symptoms

Cholesteatoma symptoms can vary, but may include the following:

• Dizziness
• Ear infection
• Facial nerve damage
• Foul-smelling drainage from the ear
• Fullness or pressure in the ear
• Hearing loss
• Loss of balance
• Ringing in your ear (tinnitus)

Cholesteatomas are not cancerous, but if they’re not treated, they can continue growing, get infected and eventually damage tiny bones in the middle ear. They can also cause loss of balance and loss of hearing in one ear. In rare cases, they can lead to meningitis, facial paralysis or a brain abscess if the cholesteatoma puts pressure on the spinal cord or facial nerves.

What causes a cholesteatoma?

There are three main types of cholesteatomas: primary acquired, secondary acquired and congenital. Each one has a different cause. Cholesteatoma is never caused by a fungus.

Primary acquired cholesteatoma

This is the most common type of cholesteatoma. It happens when the eustachian tube doesn’t drain properly or cannot equal out pressure inside the ear.

The eustachian tube is the tube that connects your facial muscles and middle ear space to your nose and sinuses. It helps regulate the pressure behind your eardrum. If the eustachian tube isn’t working properly, the eardrum can weaken and retract. When this happens, skin and earwax begin to accumulate in the space, forming a cholesteatoma.

Seasonal allergies, upper respiratory infections (coughs and colds) and sinus infections contribute to eustachian tube dysfunction.

Secondary acquired cholesteatoma

A cholesteatoma can also develop if the eardrum ruptures. In this case, the dead skin cells pass through the hole in the eardrum and accumulate in the middle ear space.

Congenital (pediatric) cholesteatoma

This rare type of cholesteatoma forms when dead skin cells become trapped inside the middle ear before birth. Children born with cholesteatoma can develop recurrent ear infections and progressive hearing loss.

Cholesteatoma diagnosis

Your doctor will start with an exam and talk with you about your symptoms. They’ll also look inside your ear with a device called an otoscope to check for abnormalities in the eardrum. They may order tests such as an audiogram, CT scan or MRI. Also, an electronystagmography can be used to study eye movements and see how well nerves in the brain are working.

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Cholesteatoma treatment

Cholesteatoma treatment often begins by treating an underlying ear infection, and then usually requires surgery to remove the cyst. To treat the infection, your doctor will carefully clean your ear and prescribe oral antibiotics (taken by mouth) and ear drops to help stop the drainage.

Cholesteatoma surgery

The main goal of cholesteatoma surgery is to remove the cyst and create a dry, safe ear. If there's damage inside the ear, including cases requiring cholesteatoma treatment, surgery may also involve reconstructing the eardrum, removing bone behind the ear, rebuilding the hearing bones or repairing a damaged eardrum.

If surgery is needed to remove the cholesteatoma, options include:

• Mastoidectomy – performed if the cholesteatoma has grown into the bone behind the ear, called the mastoid.
• Tympanoplasty – performed after the cholesteatoma is removed. Surgeons repair holes in the eardrum by grafting cartilage or the lining of the muscle behind the ear, called the fascia.

Cholesteatoma surgery takes about one to two hours and is usually performed as an outpatient procedure. Some patients may require an overnight stay, and, in rare cases of serious infection, hospitalization for IV antibiotic treatment may be required.

For patients with moderate to large cholesteatomas, a series of two surgeries is recommended. During the first surgery for cholesteatoma treatment, the surgeon meticulously removes the cholesteatoma growth and addresses any associated chronic infections to ensure comprehensive care and promote optimal recovery.

During the second cholesteatoma surgery, which is completed six to 12 months after the first, damaged middle ear bones can be repaired. If they’re too damaged to repair, the bones can be replaced with titanium replacements known as PORPs or TORPs. If the eardrum is damaged, it would also be repaired during the second surgery.

What to expect after cholesteatoma surgery

Our team of neurosurgeons and ear, nose and throat (ENT) experts will help you find the best way to protect your ear health for the future after cholesteatoma surgery. You’ll need long-term monitoring from an ENT specialist after you've had cholesteatoma treatment. Regular follow-up care may include ear exams, hearing tests and ear washing.

If the cholesteatoma comes back, more surgery could be required. Managing and preventing recurrences is crucial in cholesteatoma treatment. It’s common for people who get a cholesteatoma to need several surgeries throughout their lifetime.