cholesteatoma

What is Cholesteatoma?

Cholesteatoma is an abnormal growth in the middle ear, behind the eardrum. It is a type of skin cyst that can develop in this area and can cause various symptoms.

Types of Cholesteatoma

There are different types of cholesteatomas, including:

• Skin-lined cyst: A cholesteatoma is a skin-lined cyst that begins at the margin of the eardrum and invades the middle ear and mastoid (bone in the skull) [3].
• Abnormal growth: Cholesteatoma is an abnormal, noncancerous skin growth that can develop in the middle section of the ear, behind the eardrum [5].

Characteristics

A cholesteatoma is characterized by:

• Accumulation of squamous epithelium and keratin debris: It is an accumulation of squamous epithelium (skin cells) and keratin debris that usually involves the middle ear and mastoid [7].
• Cyst lined with squamous epithelium: A cholesteatoma is a cyst lined with squamous epithelium that can arise in an ear undergoing long periods of negative Middle Ear Pressure (MEP) [8].

Symptoms

The symptoms of cholesteatoma include:

• Drainage from the ear: Drainage or discharge from the ear is one of the main symptoms of cholesteatoma [9].
• Hearing loss: Cholesteatoma can cause hearing loss, as it invades the middle ear and mastoid.
• Earache and dizziness: Other symptoms include earache and dizziness.

Result if Left Untreated

If left untreated, a cholesteatoma may increase in size and destroy adjacent structures, including the ossicles (small bones) in the middle ear [10].

References: [1] - [10]

Common Signs and Symptoms of Cholesteatoma

Cholesteatoma, a type of skin cyst located in the middle ear and mastoid bone, can exhibit various symptoms depending on its severity and location. Here are some common signs and symptoms to look out for:

• Persistent or recurring watery discharge from the ear: This is one of the most noticeable symptoms, which can be smelly and come and go or be continuous [2].
• Gradual loss of hearing in one ear: As the cholesteatoma grows, it can impair hearing by damaging the middle ear bones or eardrum [3].
• Dizziness and balance problems: The growth of a cholesteatoma can affect the vestibular system, leading to dizziness, vertigo, and balance issues [7][9].
• Facial muscle weakness or numbness: In some cases, a cholesteatoma can cause facial paralysis or numbness due to nerve compression [7][9].
• Ear fullness or pressure sensation: Some people may experience a feeling of fullness or pressure in the affected ear [3].
• Recurring ear infections: Cholesteatomas can lead to recurring ear infections, which can be painful and uncomfortable [4].

It's essential to seek medical attention if you're experiencing any of these symptoms, as early detection and treatment can help prevent further complications.

References: [1] Not applicable [2] Symptoms of cholesteatoma · a persistent or recurring watery, often smelly, discharge from the ear, which can be smelly and come and go or be continuous. [3] A cholesteatoma is an abnormal skin growth that can develop in the middle ear. It usually begins as a collection of dead skin cells and develops into a cyst-like pocket behind the eardrum. [4] Result: ear infection symptoms | nasal congestion | discharge from the ears | dizziness | earache pain [7] What are the signs and symptoms of the condition? ... As the cholesteatoma grows, your symptoms will get worse and may include dizziness, numbness, muscle weakness in one side of the face, or blood-tinged mucus draining from one ear. [9] A cholesteatoma is an abnormal skin growth that can develop in the middle ear. It usually begins as a collection of dead skin cells and develops into a cyst-like pocket behind the eardrum.

Diagnosing Cholesteatoma: A Comprehensive Overview

Cholesteatoma diagnosis involves a combination of clinical evaluation, medical history, and various diagnostic tests to confirm the presence of this ear cyst.

• Clinical Evaluation: A healthcare provider will conduct a thorough examination of your ears using an otoscope, which allows them to visualize the eardrum. This is often the first step in diagnosing cholesteatoma.
• Medical History: Your medical history, including any previous ear infections or trauma, can provide valuable information for diagnosis.
• Imaging Tests: Various imaging tests are used to confirm the presence of a cholesteatoma and assess its extent. These include:
  • CT Scan: A computed tomography (CT) scan is often the diagnostic imaging modality of choice for cholesteatoma, as it can detect subtle bony defects in the temporal bone [5].
  • MRI Scan: Magnetic resonance imaging (MRI) scans may also be used to diagnose cholesteatoma and assess its extent.
• Other Diagnostic Tests: Additional tests such as tympanometric and audiometric tests may be performed to evaluate the function of your ears and detect any potential complications.

Early Diagnosis is Key

Early diagnosis of cholesteatoma is crucial in preventing serious complications and damage from the ear cyst. A healthcare provider may perform several tests to gather more information about the cholesteatoma and its effects on your hearing and overall health [4].

References:

[1] - A healthcare provider will ask about your symptoms and medical history, including whether you have a history of ear infections. [2] - Diagnosis is clinical based on history and otoscopic findings. CT scan of the temporal bone, provides lesion definition and extent. [3] - by TG Pachpande · 2022 · Cited by 8 — A cholesteatoma is diagnosed through otoscopic examination, CT, MRI, and tympanometric and audiometric tests. [4] - Our skilled ear, nose, and throat (ENT) specialists diagnose a cholesteatoma during an office visit. Early diagnosis is key to preventing serious complications and damage from the ear cyst. [5] - Aug 20, 2024 — CT scanning is the imaging modality of choice in the diagnosis of cholesteatoma, as it can detect subtle bony defects in the temporal bone. [6] - by S Wales · Cited by 29 — Otoscopy therefore represents the most reliable and sensitive means of diagnosing a cholesteatoma. In pathological terms cholesteatoma is simply benign ... [7] - Computed tomography (CT) scanning is the diagnostic imaging modality of choice for these lesions, as it can detect subtle bony defects. [8] - Exams and Tests · CT scan · Electronystagmography · MRI scan ...

Treatment Options for Cholesteatoma

While surgical intervention is often necessary to treat cholesteatoma, certain medications can help manage symptoms and prevent complications.

• Antibiotics: Oral antibiotics (taken by mouth) and ear drops are commonly prescribed to treat infections associated with cholesteatoma. These medications may be used in combination with other treatments, such as surgery or debridement (removal of infected tissue). [5][11]
• Topical Antibiotics: In some cases, topical antibiotics may be applied directly to the ear to help control infection and prevent further complications. [9]
• Antimicrobial Therapies: Various antimicrobial therapies, such as close follow-up and debridement, may also be used to manage cholesteatoma growth and prevent infections. [11]

Important Considerations

It's essential to note that while medications can help manage symptoms and prevent complications, they are not a substitute for surgical treatment in most cases. Cholesteatoma is often treated surgically unless contraindicated by secondary medical conditions (e.g., cardiac or pulmonary disease) that pose too high a risk for anesthesia. [11]

References

• A study by M Schürmann et al found that certain medications, such as celecoxib and meloxicam, have been proven to be useful against different forms of cholesteatoma. [4]
• According to TG Pachpande et al, surgical treatment is necessary to treat cholesteatoma, and coexistent infections are treated with local and systemic antibiotics. [8]

Differential Diagnosis of Cholesteatoma

Cholesteatoma, a type of abnormal skin growth in the middle ear and mastoid, has several differential diagnoses that need to be considered for accurate diagnosis. Here are some of the key differentials:

• Keratosis obturans: This condition presents with bilateral keratin plugs within the enlarged external auditory canal (EAC), which can mimic the appearance of cholesteatoma on imaging studies [3][5].
• Chronic suppurative otitis media: This is a long-standing infection of the middle ear that can lead to the formation of a cholesteatoma-like mass in the EAC [6].
• Otitis externa: Also known as swimmer's ear, this condition involves an infection of the external auditory canal and can sometimes be mistaken for a cholesteatoma [6].
• Benign necrotising otitis externa: This is a rare but serious form of otitis externa that can cause significant damage to the EAC and surrounding tissues [6].
• Squamous cell carcinoma: Although rare, squamous cell carcinoma of the EAC can present with a cholesteatoma-like mass and requires prompt attention for accurate diagnosis and treatment [9].
• Otitis media: This is an infection of the middle ear that can sometimes be mistaken for a cholesteatoma, especially if it leads to the formation of a mass in the EAC [8][9].
• Cholesterol granuloma: This is a rare condition characterized by the accumulation of cholesterol crystals within the EAC, which can mimic the appearance of a cholesteatoma on imaging studies [4].

It's essential to consider these differential diagnoses when evaluating patients with suspected cholesteatoma, as accurate diagnosis and treatment are critical for preventing complications and ensuring optimal outcomes.