Cholesteatoma: Causes, Symptoms, Treatment and Pictures

Cholesteatoma is an abnormal non-cancerous cyst-like growth that grows behind the eardrum in the middle ear. It can be a birth defect or can be formed from repeated infection. The cyst can eventually become bigger which could damage the smaller bones in the ear.

Cholesteatomas are benign collections of tissues in the middle ear. They are three major types of middle ear cholesteatomas:

1. Primary acquired cholesteatoma: Primary cholesteatoma occurs when an unequal pressure and improper drainage in the eustachian tube. This results in a wax buildup due to the retraction of the eardrum into the middle ear.
2. Secondary acquired cholesteatoma: Secondary acquired cholesteatoma is caused when the ruptured skin cells are collected behind the eardrum. 
3. Congenital cholesteatoma: This defect is formed during fetal development. In this condition, the skin cells become trapped in the middle ear.

The symptoms associated with cholesteatoma generally start mild. The symptoms become severe when the cysts grow in size and affect the ear. Some of the signs and symptoms of cholesteatoma are:

1. Dizziness
2. Ear discharge. It can be:
   1. Dark
   2. Sticky 
   3. Foul-smelling
   4. Pus-like
   5. Similar to earwax
3. Pain in ear
4. Altered sense of smell
5. Having a sensation of increased pressure in the ear 
6. Numbness in ear
7. Vertigo 
8. Tinnitus( ringing in the ear)

Cholesteatoma can develop in any age group or gender. Cholesteatoma is caused due to many reasons. Some of the causes of cholesteatoma are:

1. Chronic infections of the ear
2. Sinus infection
3. Cold
4. Allergies

Cholesteatoma develops due to the abnormal growth of the middle ear tissues. An individual is at a higher risk of developing cholesteatoma if he/she has:

1. Down syndrome
2. Turner syndrome
3. Chronic ear infection
4. Cleft palate
5. Improper functioning of the Eustachian tube
6. Having a family history of cholesteatoma
7. Having multiple ear infections during childhood

Unfortunately, the congenital cholesteatoma cannot be prevented. However, an individual can take the following preventive measures for cholesteatoma to reduce the condition from worsening.

1. In most cases, cholesteatoma is caused by ear infections. Therefore, diagnosing and treating ear infections at an early stage will help in preventing cholesteatoma
2. Early treatment of cholesteatoma is necessary to prevent further complications.

An ENT (ear, nose, and throat) specialist can diagnose a cholesteatoma using various methods such as:

1. Physical examination: During a physical examination, the doctor will examine the ear using a device known as an otoscope. An otoscope is a device that delivers a beam of light for viewing the internal space of the ear.
2. Hearing test: The doctor may also perform a hearing test known as an audiogram to access the eardrum, middle ear and hearing.
3. CT scan (computerized tomography scan): This includes a series of X-rays showing a detailed picture of the internal structures like bones, blood vessels and tissues of the ear. This test helps in the examination of the damaged bones in the ear.
4. MRI (Magnetic Resonance Imaging): This test may help the doctor detect the spread of the ear infection to the brain.

How to prepare for the doctor's consultation?

If an individual has signs or symptoms of a cholesteatoma, then consult the ear, nose and throat (ENT) specialist. Below mentioned are some of the information that a patient can prepare before the appointment with the specialist.

1. List down symptoms including any that may seem unrelated to hearing loss, fluid discharge or other ear-related symptoms.
2. List down the relevant events that may be related to the ear problems, such as a history of infections, recent ear injuries or head traumas, or recent air travel.
3. The patient should also tell the specialist the list of medications and supplements he/she takes.
4. Ask questions to the specialist. Some of the questions are as follows:
   1. What is the cause of my hearing loss?
   2. What is the best treatment for the condition?
   3. What type of follow-up appointments will I need?
   4. At what point do we need to consider other treatments?

Once a cholesteatoma has been identified, an antibiotic treatment plan, ear drops, and meticulous ear cleaning will probably be advised to treat the infected cyst, lessen inflammation, and drain the ear. The cyst's growth characteristics can then be more thoroughly examined by the doctor, who can formulate a surgical removal strategy. Some of the treatment options for cholesteatoma are:

Cholesteatoma treatment without surgery

1. Hearing aid: The doctor may also prescribe artificial hearing aid after completion of the surgery for better hearing.
2. Medication: If there is an excessive fluid secretion in the ear due to an infection, it is necessary to dry the ear before surgery and prevent further infections after the surgery. The doctor may prescribe antibiotic ear drops to prevent further infection.

Cholesteatoma treatment with surgery

Almost all patients detected with cholesteatoma need one of the following surgery mentioned below.  In some cases, the combination of both surgeries may be necessary.

1. Mastoidectomy: It involves the removal of the mastoid (bone behind the ear) in the ear. It is removed to stop the further spread of the infection. This surgery is of two types.
   1. Open cavity: In this approach, the whole mastoid bone is removed to form a cavity in the ear. This is why this surgery is called open surgery.
   2. Closed cavity: In this approach, the mastoid bone wall is preserved, leaving behind the canal-like cavity.
2. Tympanoplasty: It involves the repair of the eardrum and hearing problems. The eardrum is repaired using a cartilage graft or the lining of the muscles behind the ear.

Cholesteatoma can damage the bones in the middle ear or cause inner ear damage if not treated in time. Other risks and complications of cholesteatoma include:

1. Brain abscess
2. Meningitis
3. Loss of hearing
4. Spread of cyst into the brain
5. Bone erosion may increase the chances of infection and other conditions like developing abscesses and causing facial paralysis

When to see a doctor?

The patient can consult the doctor if he/she experiences:

1. Ear pain
2. Hearing loss
3. Ringing of ear
4. Spinning sensation
5. Nausea and vomiting

Dietary habits cannot treat cholesteatoma. However, diet can help reduce the risk of developing the condition. Some minerals are also critical elements in improving hearing health. These include:

1. Potassium: regulates the fluid in the inner ear. Foods rich in potassium include potatoes, spinach, lima beans, tomatoes, raisins, apricots, bananas, melons, oranges, yoghurt and low-fat milk
2. Folic acid: helps the body to generate new cell growth and helps increase the circulation of blood in the body. Foods rich in folic acid include fortified breakfast cereal, liver, spinach, and broccoli.
3. Magnesium: acts as a protective barrier to hair cells in the inner ear when loud noises are emitted. Foods rich in magnesium include bananas, potatoes, spinach and broccoli.
4. Zinc: is known for increasing cell growth and healing wounds. Zinc-rich foods include cashews, almonds, peanuts, beans, and split peas.
5. Omega 3 Fats and Vitamin D: have anti-inflammatory and anti-ageing properties. Foods rich in Omega 3s include flaxseed oil, krill oil, salmon, and soybean oil.