cholesteatoma of middle ear

What is Cholesteatoma?

Cholesteatoma is a type of skin cyst that develops in the middle ear and mastoid bone in the skull. It's a non-cancerous growth that can cause damage to the delicate structures inside the ear.

Causes and Symptoms

Cholesteatoma can be caused by chronic ear infections, congenital defects, or when skin from the outer ear canal passes through a hole in the eardrum into the middle ear. The most common symptom is a smelly discharge from the ear, but it can also cause hearing loss and dizziness.

Types of Cholesteatoma

There are several types of cholesteatomas, including:

• Congenital: present at birth
• Acquired: develops as a result of chronic ear infection or other factors
• Primary: develops in the middle ear and mastoid bone
• Secondary: develops in the external auditory canal

Characteristics

A cholesteatoma is an abnormal collection of skin cells deep inside the ear. It's a rare but potentially destructive growth that can cause recurrent ear infections if left untreated.

References

• [1] Cholesteatoma is a type of skin cyst that begins at the margin of the eardrum and invades the middle ear and mastoid. (Source: #5)
• [2] A cholesteatoma is an abnormal collection of skin cells deep inside your ear. They're rare but, if left untreated, they can damage the delicate structures... (Source: #7)
• [3] Cholesteatomas are lesions that most often arise within pneumatized portions of the temporal bone to include the middle ear and mastoid, or both, and are only rarely found within the external auditory canal. (Source: #11)

Common Signs and Symptoms of Cholesteatoma

A cholesteatoma, an abnormal skin growth in the middle ear, can cause a range of symptoms that may vary from person to person. Here are some common signs and symptoms:

• Persistent or recurring watery, often smelly, discharge from the ear: This is one of the most common symptoms of cholesteatoma, occurring in 9 out of every 10 cases [4].
• Hearing loss: Conductive hearing loss can occur due to the growth of the cholesteatoma, affecting the middle ear bones or other structures [6][15].
• Dizziness: This is an occasional symptom that may be caused by the cholesteatoma's impact on the balance organ in the inner ear [12].
• Facial nerve damage: In rare cases, a cholesteatoma can cause facial muscle paralysis due to its proximity to the facial nerve [10][13].
• Foul-smelling drainage from the ear: This symptom is often associated with an infected cholesteatoma [5].
• Fullness or pressure in the ear: Some people may experience a feeling of fullness or pressure in their affected ear [7].

Other Possible Symptoms

In addition to these common symptoms, some people may also experience:

• Ear infection: A cholesteatoma can increase the risk of recurrent ear infections [3].
• Tinnitus: A ringing or "whooshing" sound in the affected ear can occur due to the cholesteatoma's impact on the middle ear bones [11].

Important Note

It is essential to seek medical attention if you experience any of these symptoms, as a cholesteatoma can lead to serious complications, such as brain abscess or meningitis, if left untreated.

Diagnostic Tests for Cholesteatoma of Middle Ear

Cholesteatoma, a type of skin cyst located in the middle ear and mastoid bone, requires accurate diagnosis to determine its extent and impact on surrounding structures. The following diagnostic tests are commonly used to diagnose cholesteatoma:

• Otoscopic examination: A thorough visual inspection of the ear canal and eardrum using an otoscope is essential for diagnosing cholesteatoma (1). This test can reveal a pocket or opening (perforation) in the eardrum, often with drainage (7).
• Computed Tomography (CT) scan: CT scanning is the diagnostic imaging modality of choice for detecting subtle bony defects in the setting of middle ear and/or mastoid cholesteatoma (4). This test can help determine whether the cholesteatoma has spread and which parts of the ear are affected.
• Magnetic Resonance Imaging (MRI): MRI may be used to further evaluate the extent of the cholesteatoma, particularly in cases where CT scans are inconclusive (8).
• Audiometric tests: Audiometry is performed to determine the hearing level remaining in the ear and the extent of destruction caused by the cholesteatoma (13). These tests can help identify any hearing loss associated with the condition.
• Tympanometry and electronystagmography: Tympanometry and electronystagmography may be used to study eye movements and assess how well nerves in the ear are functioning (8).

Additional Tests

In some cases, additional tests such as:

• Biopsy: A biopsy may be performed to confirm the diagnosis of cholesteatoma or rule out other conditions.
• Imaging studies: Imaging studies like CT scans or MRI may be ordered to evaluate the extent of the cholesteatoma and its impact on surrounding structures.

Citations

1. Cholesteatoma is an accumulation of squamous epithelium and keratin debris that usually involves the middle ear and mastoid (1).
2. CT scanning is the diagnostic imaging modality of choice for these lesions, as it can detect subtle bony defects in the setting of a middle ear and/or mastoid cholesteatoma (4).
3. An ear exam may show a pocket or opening (perforation) in the eardrum, often with drainage (7).
4. These tests are performed to determine the hearing level remaining in the ear and the extent of destruction caused by the cholesteatoma (13).
5. Surgery is performed under general anesthesia in most cases. The primary purpose of the surgery is to remove the cholesteatoma and infection, and achieve an infection-free, dry ear (13).

Treatment Options for Middle Ear Cholesteatoma

Middle ear cholesteatoma (MEC) is a destructive and locally invasive lesion in the middle ear driven by inflammation, with an annual incidence of 10 per 100,000. While surgical removal of the cholesteatoma is the primary treatment option, drug treatment can also play a role in managing this condition.

Topical Antibiotics

Topical antibiotics are often used to surround the cholesteatoma and suppress infection, with some studies suggesting that they can penetrate a few millimeters toward its center [4]. This approach may be particularly useful in cases where surgical intervention is not immediately possible or desirable.

Vitamin D3

Research has also explored the potential of Vitamin D3 as a treatment for MEC. By reducing the activation of Th1 cells and inhibiting Th1 cytokine secretion, Vitamin D3 may help to mitigate the inflammatory response driving the cholesteatoma [9]. However, more studies are needed to fully understand its efficacy in this context.

Other Treatment Options

While drug treatment can be a useful adjunct to surgical management, it is essential to note that MEC often requires surgical intervention to remove the cholesteatoma and prevent further complications. Other treatment options may include mastoidectomy, which involves opening the bone behind the ear to remove disease [6], as well as endoscopic ear surgery, which can be used to treat acquired cholesteatoma [14].

Key Takeaways

• Topical antibiotics can help suppress infection surrounding the cholesteatoma.
• Vitamin D3 may have a role in reducing inflammation and inhibiting Th1 cytokine secretion.
• Surgical removal of the cholesteatoma is often necessary to prevent further complications.

References:

[4] - Topical antibiotics often surround the cholesteatoma, suppress infection, and penetrate a few millimeters toward its center. [9] - To reduce the activation of Th 1 cells and inhibit Th 1 cytokine secretion, the clinically approved drug Vitamin D3 known as treatment primarily against osteoporosis (or any cause ... [14] - CWU procedures are suited to cholesteatoma with middle ear involvement and disease in the mastoid or disease extension through the facial recess. ... Can endoscopic ear surgery replace microscopic surgery in the treatment of acquired cholesteatoma? A contemporary review. Int J Pediatr Otorhinolaryngol. 2020; 131, 109872. Crossref. Scopus (22 ...)

Differential Diagnoses for Middle Ear Cholesteatoma

Middle ear cholesteatoma, a benign collection of keratinized squamous epithelium in the middle ear, can be challenging to diagnose due to its similarity with other conditions. The differential diagnoses for middle ear cholesteatoma include:

• Cerumen (earwax): Located in the external ear canal, cerumen can show similar image characteristics to cholesteatoma but has a different clinical presentation [2].
• Abscess formation in the middle ear: This condition can also present with similar imaging findings but has a distinct clinical presentation [3].
• Cholesterol granuloma: A cholesterol granuloma shows high T1W change and is often confused with cholesteatoma, which has high DWI (diffusion-weighted imaging) MRI signal [4].
• Middle ear and mastoid effusion: This condition may be secondary to Eustachian tube dysfunction and can present with similar symptoms to middle ear cholesteatoma [5].

Other Differential Diagnoses

In addition to the above conditions, other differential diagnoses for middle ear cholesteatoma include:

• Facial nerve schwannoma: A facial nerve schwannoma can present as a mass in the middle ear with bony erosion and is often confused with cholesteatoma [13].
• Tympanic paraganglioma: This rare tumor can also present as a mass in the middle ear with bony erosion and may be mistaken for cholesteatoma [13].

References

[1] Context 4 [2] Context 2 [3] Context 3 [4] Context 7 [5] Context 10