Cholesteatoma Treatment and Surgery in NYC

A cholesteatoma is a collection of skin cells and keratin that becomes trapped in the middle ear, usually behind the eardrum. It can develop when the eardrum becomes retracted or perforated, allowing skin cells to accumulate in an abnormal pocket.

Cholesteatomas may also develop following chronic ear infections or, less commonly, may be present from birth.

Although cholesteatomas are benign, they can continue to grow. As they enlarge, they may erode the tiny bones responsible for hearing and damage other structures within and around the ear.

Some cholesteatomas produce few symptoms in their early stages. As the condition progresses, patients may experience:

• Hearing loss, particularly conductive hearing loss
• Persistent or recurrent ear drainage
• Foul-smelling discharge from the ear
• Recurrent ear infections
• Ear pressure or fullness
• Ear pain or discomfort
• Tinnitus
• Dizziness or vertigo

Facial weakness or more significant balance problems can occur when a cholesteatoma affects structures deeper within the ear.

Persistent ear drainage, especially when associated with hearing loss or recurrent infections, should be evaluated by an ear specialist.

A cholesteatoma often develops when the eardrum becomes retracted and creates a pocket that collects dead skin cells. Chronic middle-ear infections and a perforated eardrum can also contribute to the development of a cholesteatoma.

There are two general forms:

Acquired cholesteatoma develops over time, commonly in association with eardrum retraction, chronic ear disease, or a perforated eardrum.

Congenital cholesteatoma is present from birth and may be discovered during an examination even when there is no history of chronic ear infections.

Regardless of how it develops, a cholesteatoma can progressively damage the structures of the ear if it is not appropriately treated.

Diagnosis begins with a detailed examination of the ear. Dr. Sperling may use microscopic or endoscopic examination to evaluate the eardrum, ear canal, and middle ear for trapped skin, retraction pockets, drainage, or other evidence of cholesteatoma.

A hearing test (audiogram) is typically performed to determine whether the cholesteatoma has affected hearing and to establish a baseline before treatment.

A CT scan of the temporal bones may be recommended to determine the extent of the disease and evaluate whether the cholesteatoma has eroded the ossicles or other surrounding bone. In selected situations, MRI may also be useful, particularly when evaluating for residual or recurrent disease.

In many cases, definitive treatment requires surgical removal of the cholesteatoma.

The primary objective is not simply to improve hearing. The first priority is to completely remove the disease, control infection, and create a safe, dry ear while protecting the structures of the ear whenever possible.

Hearing restoration is an important secondary objective and may be addressed during the initial operation or during a later procedure, depending on the extent of disease and the condition of the middle-ear structures.

Small areas of trapped skin may sometimes be managed with careful microscopic cleaning and close observation. However, a cholesteatoma that extends into the middle ear or mastoid commonly requires surgery.

The specific operation depends on the location and extent of the cholesteatoma.

Tympanoplasty

A tympanoplasty repairs and reconstructs the eardrum. It may be performed when the eardrum has been damaged or perforated by chronic ear disease or the cholesteatoma.

Mastoidectomy

A mastoidectomy removes diseased tissue from the mastoid bone behind the ear. When a cholesteatoma has extended into the mastoid, mastoid surgery may be necessary to remove the disease and establish a safe ear.

Tympanomastoidectomy

A tympanomastoidectomy combines eardrum reconstruction with removal of disease from the middle ear and mastoid. This is commonly used when a cholesteatoma involves both areas.

Ossicular Chain Reconstruction

The cholesteatoma may erode one or more of the three small hearing bones—the malleus, incus, and stapes. When this occurs, ossicular chain reconstruction may be performed to rebuild the pathway that conducts sound from the eardrum to the inner ear.

Whether hearing reconstruction can be performed at the time of cholesteatoma removal depends on the extent of disease and the condition of the remaining middle-ear structure

The goals of cholesteatoma surgery are to:

• Remove the cholesteatoma completely
• Eliminate infected or diseased tissue
• Prevent further erosion of the ear bones
• Protect the facial nerve and inner ear
• Create a safe, dry ear
• Preserve existing hearing whenever possible
• Reconstruct the hearing mechanism when appropriate

Hearing improvement is possible, but it is important to understand that the first priority is controlling the cholesteatoma and preventing further damage.

Yes. A cholesteatoma can damage the ossicles, which are responsible for transmitting sound through the middle ear. This can result in conductive hearing loss.

More extensive disease can affect the inner ear and potentially cause more significant or permanent hearing impairment.

Removing the cholesteatoma can prevent additional damage. When the anatomy allows, ossicular reconstruction can also improve the transmission of sound and potentially improve hearing.

Yes. Cholesteatomas can recur or, in some cases, residual disease may remain after surgery.

For this reason, long-term follow-up is an important part of cholesteatoma treatment. Follow-up may include microscopic ear examinations, hearing tests, and, when appropriate, imaging such as diffusion-weighted MRI.

Depending on the extent of disease and the surgical technique used, some patients may require a second operation to evaluate or remove residual or recurrent cholesteatoma and, when appropriate, complete hearing reconstruction.

Recovery varies according to the type and extent of surgery performed.

Patients typically require follow-up examinations to monitor healing and make sure the ear remains free of disease. Hearing may initially be unchanged or temporarily worse, particularly when reconstruction of the hearing bones is performed at a later stage.

The long-term objective is to maintain a safe, healthy ear while preserving or improving hearing whenever possible.

You should have your ear evaluated if you experience:

• Persistent or recurrent drainage from the ear
• Foul-smelling ear discharge
• Repeated ear infections
• Unexplained hearing loss
• A feeling of pressure or fullness in the ear
• Tinnitus
• Persistent ear pain
• Dizziness or vertigo

A cholesteatoma can sometimes progress without significant symptoms. Early evaluation can help identify disease before it causes more extensive damage.