Cholesteatoma

What is a cholesteatoma?

Cholesteatoma (also called pearly tumor) refers to benign accumulations of keratinizing epithelial cells growing into the middle ear and resulting in a chronic purulent middle ear inflammation with involvement of the adjacent bones.

Why does the cholesteatoma form and is it serious?

Most commonly, a cholesteatoma is due to a defective eardrum. The eardrum in a healthy ear is not only a sound transmitter, but a physical barrier separating the external auditory canal from the middle ear. The keratinizing layer of epithelium covering the external auditory canal is similar to the skin and an intact eardrum walls it off from the sensitive middle ear, that is lined only with a fine layer of cells. Consequently, if the eardrum is injured, cells of the external auditory canal will be able to invade the middle ear and form pearl-like tumors. This disrupts the outflow of secretions, but also triggers inflammatory processes within such cholesteatomas, which can later infiltrate the surrounding bones and destroy bone tissue. In addition, the sensitive auditory ossicles, responsible for the acoustic transmission of sound to the inner ear, may be destroyed. Moreover, a so-called superinfection may develop, in which hostile germs colonize the damaged tissue and cause further harm.

A cholesteatoma needs to be recognized and treated at an early stage, as if left unattended, the inflammation will continue to spread and finally reach important structures like adjacent bones, the inner ear (hearing loss) or, in severe cases, even the meninges (meningitis).

Symptoms and diagnosis: How can a cholesteatoma be recognized?

Early symptoms are foul-smelling discharge from the ear and progressive hearing loss. Patients experiencing symptoms associated with inflammation, such as fever, dizziness, ear pain, headache, numbness, or facial muscle dysfunction, need to seek medical attention right away.

Cholesteatoma surgery

The aim of surgery is to remove the cholesteatoma completely and to preserve or improve hearing as much as possible. A variety of microsurgical techniques are employed that are tailored to the specific circumstances, for instance how advanced the inflammation is and what adjacent structures, particularly the auditory ossicles, remain intact. To control the inflammation, adjunctive antibiotic therapy is usually started.

For the removal of the cholesteatoma, there is no alternative to surgery.

Procedure and duration

The surgery is done under general anesthesia and normally takes about 4 hours.

A small skin incision is made behind the auricle to access the middle ear and remove the cholesteatoma completely, if possible, as well as all damaged structures by means of special instruments. Next, the status of the structures that remain is carefully assessed, after which surgical reconstruction (i.e., rebuilding) is performed.

Using the patient's own cartilage tissue from the outer ear, the eardrum is reconstructed. In case the ossicles are damaged, it is possible to make use of a wide range of artificial prostheses. As a result, hearing can be restored.

Risks and follow-up

Most patients see their doctor at an early stage, which allows careful planning of the operation. This allows any complications to be kept to a minimum while the benefits of this procedure greatly outweigh the risks. Despite being experienced and careful, any surgical procedure comes with a remaining level of risk, making complications such as increased discharge from the ear, tinnitus, or damage to facial nerves a rare occurrence, but one that cannot be ruled out.

Following surgery, patients are required to keep a tamponade in their ear for about 3 weeks, which are changed regularly. It is important for patients to continue regular check-ups with a physician in the years following surgery, because cholesteatoma can recur.

Nonetheless, the prognosis is very good and typically it is possible to completely remove the cholesteatoma and restore hearing.

What clinics and doctors specialize in cholesteatoma?

ENT specialists and clinics with a surgical focus are the right contacts.

If you're in need of a doctor, you expect the best medical care possible. So of course patients are curious to find out what clinic to go to. As there is no objective way to answer this question and a legitimate doctor would never claim to be the best, patients must rely on a doctor's experience.

Let us help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in the field of cholesteatoma and are looking forward to your inquiry or wish for treatment.