Treatment for Cholesteatomas

A diagnosis of cholesteatoma, a psuedotumor of the middle ear, can be scary. Possible complications of untreated cholesteatomas are permanent hearing loss, facial nerve damage, meningitis and in rare cases, death. Fortunately, such complications are now rare due to improved treatments and surgical techniques.

The most common treatment for cholesteatoma is surgical removal of the cyst. Depending on the size and location of the cholesteatoma, surgery can be done through the ear canal, or for large cysts or more involved disease process, an incision is made behind the ear to allow the surgeon to have access to the middle ear.

The first priority of the surgeon is to remove the cholesteatoma and any infected tissues, such as the ossicular chain and the part of the mastoid bone. If successful, the patient will be left with an ear clear of infection and drainage. The next priority is the preservation or reconstruction of hearing. If the cholesteatoma has invaded the bone that separates the ear canal from the mastoid, the bony wall is removed, leaving a large open mastoid cavity. This operation was the standard treatment for all cholesteatomas, but most surgeons now attempt to leave the canal wall intact. If the canal wall is removed, the mastoid cavity remains open and is vulnerable to infection and will need frequent office visits for hygiene treatments, including suctioning of the cavity. Some surgeons that perform this radical canal wall down mastoidectomy will reconstruct the wall in a staged procedure. Advantages to the canal wall up procedure is easier restoration of hearing, reduced risk of chronic infection, and the ability to allow water in the ear. Cholesteatomas can recur, and the canal wall up surgery can make new cholesteatomas hard to detect.

Adults that had the canal wall down radical mastoidectomy as children are now candidates for surgical reconstruction. Reconstruction can eliminate the chronic drainage plagues many mastoidectomy patients.

If the ossicular chain was involved, removal of these bones will be necessary. The incus and malleus are almost always removed, but the stapes is frequently left so that an ossicular replacement can be affixed to the bone. Prosthetic ossicular replacements can be implanted to restore conductive hearing loss. Common materials for ossicular prostheses include titanium and in some cases biomaterial is used in place of titanium.

In cases of very small, slow growing cholesteatomas, some patients elect to use antibiotics to clear an infection and keep a watchful eye on the cholesteatoma and remove it only if it becomes destructive or large.