Cholesteatoma

Any condition that can impact your ability to hear can be detrimental to your overall quality of life. That’s especially true when the disorders are rarer and more difficult to treat, like cholesteatoma.

The ear, nose and throat (ENT) doctors at The Ohio State University Wexner Medical Center are specially trained and equipped to help people dealing with cholesteatoma, which grow in the ear and can cause hearing loss, among other problems. Health care providers from around the state and region refer their patients to this hospital regularly because of our nationally ranked Department of Otolaryngology – Head and Neck Surgery and the fact that many of the best neurotologists in the state of Ohio are found here.

What is a cholesteatoma?

A cholesteatoma is a noncancerous growth, or cyst, that forms within the skin behind the eardrum (in the middle ear space or mastoid bone). Once the cholesteatoma is formed, it can cause the bones of the middle ear to malfunction, resulting in hearing loss. If left untreated, further cholesteatoma growth can cause permanent hearing loss, facial muscle paralysis and infections that spread to the brain.

Causes of cholesteatoma

A cholesteatoma forms when skin cells become trapped and build up into a cyst, which is a sac-like cluster of tissue near the eardrum or in the middle ear space. This happens for several reasons, including:

• Chronic ear infection
• Ruptured eardrum
• Congenital birth defect
• Prior ear tube placement
• Chronic ear fluid
• Eustachian tube dysfunction

Cholesteatoma symptoms

When a cholesteatoma first appears, it might not cause any symptoms; however, as it grows larger, you will begin to notice signs that you have one. Often, the first symptom is ear drainage or discharge. As the cyst grows larger, it can become infected, causing other symptoms, including:

• Hearing loss
• Pain behind the ear
• Pressure within the ear
• Foul smelling drainage
• Dizziness and balance issues
• Altered sense of smell
• Facial paralysis
• Fevers or meningitis

Diagnosing cholesteatomas

During an ear examination, an Ohio State Wexner Medical Center neurotologist will use an otoscope or microscope to look inside the ear for signs of a cholesteatoma.

If it’s determined you have one, our specialists will also use hearing evaluation, balance tests and noninvasive imaging through CT scans or MRI to help identify the hearing level in the infected ear and the damage caused by the cholesteatoma. This will also rule out other causes of your symptoms.

Treatment of cholesteatomas

Cholesteatoma treatment almost always begins with eliminating any infections currently in the ear. We’ll use a combination of methods to do this, including:

• Antibiotics
• Ear cleaning
• Ear drops

These methods will clear up fluid drainage and ease pain, but they aren’t cures. Cholesteatoma requires surgical removal in almost all cases. If left untreated, complications including brain injury, deafness and meningitis (an inflammatory infection) can arise. Depending on the size and stage of the cyst, these three types of surgeries are typically used to treat cholesteatomas:

• Mastoidectomy: a surgical procedure to remove infected cells in the mastoid, which is the large bone behind the ear
• Tympanoplasty: a surgical technique that patches the eardrum with a graft
• Ossiculoplasty: a surgical technique that repairs the hearing bones with a prosthesis or other materials

Follow-up visits are usually advised to monitor for recurrence of cholesteatoma. You may also need to have regular ear-cleansing visits to guard against reinfection.