What is a Cholesteatoma?

Every parent knows the signs of an ear infection- pain, fever, irritability and a malodorous drainage from the ear. But sometimes the common symptoms can indicate a more serious problem, such as a cholesteatoma. A cholesteatoma is a small sac that can result from a tear or puncture of the eardrum. A small tear in the eardrum will usually heal itself, but in a small number of cases, the tissue will grow through the eardrum, forming a small tumor. Skin cells collect in the sac and a small cyst or tumor will form.Because the cholesteatoma does not have its own blood supply, it is more correctly classified as a pseudotumor, although there is controversy about this designation. Cholesteatomas are not cancerous, although they are destructive and can be dangerous if ignored or left untreated.

To diagnose a cholesteatoma, an otologist (a surgeon that specializes in ear disorders) will use a surgical microscope to view the ear canal, as well as a review of symptoms such as drainage and hearing loss. Cholesteatomas secrete enzymes that are activated by moisture found in the ear canal. If left untreated, cholesteatomas can erode the three bones that make up the ossicular chain, causing conductive hearing loss. If the cholesteatoma is allowed to progress, it can erode bone in the inner ear, the mastoid, and the thin layer of bone that separates the ear canal from the brain cavity. Because this leads the brain exposed to the tumor, enzymes and bacteria from the ear canal, brain infections, meningitis, facial paralysis and, in very rare cases, death.

While a visual examine with a surgical microscope can confirm a cholesteatoma diagnosis, a CT scan is required once the diagnosis has been made. A CT scan allows the doctor to see how much the bones have eroded and whether the cholesteatoma has invaded the inner ear of brain cavity. If signs of infection are present, antibiotic treatment may be initiated before surgical intervention is planned.

While an eardrum injury is a common cause of cholesteatomas, a retraction of the eardrum due to Eustachian tube dysfunction can also cause them. Acquired cholesteatomas account for most cases, but congenital cholesteatomas are relatively common in a pediatric setting. Congenital cholesteatomas are most often diagnosed after hearing loss is noticed. They are usually found behind an undamaged eardrum and are seldom infected. They can still cause bone erosion, so treatment is still necessary.

Most ear drainage is a sign of a simple infection, but if you or your child suffers from recurring ear infections or unexplained hearing loss, schedule an appointment with your otologist.