Learn more about cholesteatomas and how they can be treated.
Skin cells in the ear sometimes form a small sac called a cholesteatoma. These abnormal growths, while non-cancerous (benign), may cause problems with hearing and balance if not treated. Cholesteatomas typically develop deep with the ear and move towards the middle and inner parts of the affected ear.
Affecting nine out of every 100,000 adults in the United States, the growths aren’t common
However, signs of having a cholesteatoma that may include foul-smelling drainage and a plugged-up sensation shouldn’t be ignored
Chronic ear infections or an injury may trigger the development of a cholesteatoma. Trapped fluid and poor function in the small passageway that connects the throat to the middle ear (eustachian tube) may also contribute to the formation of sacs in the ear. A vacuum in the ear sometimes forms if this tube becomes weak after ear surgery or as a result of allergies or a cold, and contributes to the development of cholesteatomas when the tube collapses and becomes a pocket. Growths caused by ear infections are the most common.
Common Signs and Symptoms
Other than an odorous drainage from the ears and a “fullness" sensation, signs of a cholesteatoma may include pain behind the ear, hearing problems, and issues with balance. Facial paralysis may be experienced in some instances. Additional symptoms associated with cholesteatomas include:
Persistent noise or ringing in the affected ear (tinnitus)
Difficulty hearing in one ear
Dizziness or vertigo
Diagnosis typically involves an examination of the affected ear. A device with a magnifying glass and a light called an otoscope is often used to view the inside of the ear. A hearing test may also be done to determine if the abnormal growth is affecting hearing. Patients who first see their primary care physician are usually referred to an ear, nose, and throat specialist for further evaluation if a cholesteatoma is suspected or detected with an initial ear exam.
If facial paralysis is one of the symptoms that a patient experiences, an MRI may be done to confirm that it is actually a cholesteatoma causing it. A CT scan is sometimes performed to get a better view of how an ear is affected by one or more growths prior to surgery.
Outpatient surgery is the most common treatment option recommended for a cholesteatoma. The procedure typically involves cleaning the ear and applying antibiotics to treat any infection that may be present prior to removing the growth. Otoendoscopes and lasers are usually used for the procedure. If middle ear bones are damaged, a second operation may be necessary.
Surgery often involves one of two specific procedures. With a mastoidectomy, the bone behind the ear (mastoid bone) is opened to remove the cyst. Damage to the eardrum is repaired with a tympanoplasty. Muscle or cartilage from another part of the ear is used to fill any holes.
Can Cholesteatomas Be Avoided?
Anything out of the ordinary with one or both ears should be reason enough to see a doctor, which is often the best way to avoid serious issues with cholesteatomas. Having ear infections evaluated sooner rather than later can reduce the risk of developing cholesteatomas, especially if those infections keep coming back on a regular basis.
Efforts should also be made to be cautious with certain activities that may involve pressure on ears or result in an injury. Proper ear care is just as important, as are regular follow-up visits after treatment.
What Happens If Cholesteatomas Aren’t Treated?
If a cholesteatoma isn’t treated, it may eventually spread to other parts of the affected ear. When this happens, more severe symptoms may be experienced. For instance, a cholesteatoma may extend to the part of the ear that controls balance and result in noticeable difficulty maintaining balance or walking without stumbling or falling down.
In rare cases, abnormal growths may reach the inner ear or brain. If cholesteatomas reach the brain, pus-filled swelling may contribute to meningitis, although this is also a rare occurrence. A cholesteatoma will not heal on its own, and it could also break delicate middle ear bones if not treated when symptoms become evident.
Men are more likely to develop cholesteatomas than women, although anyone may develop them at any age. In rare instances, cholesteatomas are seen in developing babies when part of the ear’s lining gets trapped inside growing bone. Once treated, the abnormal growths aren’t likely to return if all of the abnormal tissues are removed.