Ear, Nose and Throat
Elizabeth A. Kelly, M.D.
March 11, 2020
Cholesteatoma is a common chronic ear disease that we see in the ENT practice but most of the time with patients that have ear infections, a small percentage of them develop into cholesteatoma. Cholesteatoma is a area of trapped skin that gets built up behind the ear. It will cause local destruction of the structures within the ear.
Cholesteatoma develops because there's some eustachian tube dysfunction so the tube that ventilates the ear, lets air stay behind there isn't working adequately and so we get a negative pressure and the eardrum will get suctioned in and it has a little pocket that forms. Normally the eardrum will slough off skin and so that skin gets caught or stuck in that pocket and then it continues to grow slowly over time and then can develop further destruction into the ear and progress further. Other times that it can develop is if someone has a hole in the eardrum. Sometimes the skin from the eardrum surface can travel underneath and cause that as well. It usually looks like a pearl and so bright white and sometimes forms like a nice capsule around it.
Sometimes cholesteatoma can go on for a while before patients are really noticing some symptoms. Usually the symptoms can include hearing loss or they can have drainage from the ear usually the drainage can be chronic and it will persist even after treating an infection. Cholesteatoma can cause a lot of damage in the ear so it can destroy those little bones of hearing and so lead to hearing loss. It can also extend over one of the nerves that travels through the ear that controls the muscle of your face, so can lead to a facial weakness. In more advanced cases it can eat into the inner ear and cause dizziness or more of a sensory neural or nerve hearing loss as well as lead to brain infection. Most cholesteatoma is treated with surgery so in some cases if there's an infection with the cholesteatoma we treat the infection first but antibiotic for other treatments is going to make the skin cyst go away, so we have to surgically remove that.
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