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Cholesteatoma and its management
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Cholesteatoma and its management

Cholesteatoma, an abnormal build-up of skin cells deep within the ear, can harm crucial structures needed for hearing and balance if not treated promptly
cholesteatoma, cholesteatoma treatment, cholesteatoma causes, what is cholesteatoma, ear cyst
Representational image | Shutterstock

Cholesteatoma, sometimes known as benign ear cyst develop inside the middle ear, behind the ear drum.  They occur when dead skin cells get stuck deep inside our ears. Some individuals are born with them, although this occurrence is quite rare.

What is cholesteatoma?

Dr H K Susheen Dutt, an ENT specialist at Fortis Hospital in Bengaluru, explains that cholesteatoma is an unusual occurrence where skin cells grow in an abnormal manner deep within the ear, particularly in the middle ear and its inner regions. “While these occurrences are infrequent, neglecting them can damage the fragile components essential for your hearing and balance,” he says.  Furthermore, cholesteatoma can trigger ear infections, resulting in ear discharge.

The location of a cholesteatoma matters because if it gets larger, it can harm the fragile bones in the middle ear and may even reach the inner ear. This can affect our hearing, balance, and the way our facial muscles work.

Cholesteatoma in children

Cholesteatoma can be congenital, which means it can be present at the time of birth or acquired. The acquired type can affect  children and adults.

In a 2018 study conducted by a team led by Julia Nagel and Saskia Wöllner from the Department of Otolaryngology at Klinikum Bielefeld, Germany, it was found that  around 2-4 per cent of cholesteatoma cases are congenital in children aged four to six.  Interestingly, children with a cleft palate are at a significantly higher risk of developing cholesteatoma.

Causes

Dr Dutt says that cholesteatoma can manifest with various troubling symptoms, including:

Ear discharge: This may not only be bothersome but can also emit a foul odour

Ear pain: Aching discomfort within the ear can be a sign of this condition

Hearing loss: Your ability to hear can progressively decline as cholesteatoma develops

Dizziness: This sensation of unsteadiness is a common symptom

Balance problems: Cholesteatoma can lead to giddiness, affecting your sense of balance

A sense of ear fullness or pressure: You might feel like your ear is constantly under pressure

Dr Dutt says that unlike simple ear infections that typically respond to antibiotics, ear discharge caused by cholesteatoma may not improve with medication. “As the condition progresses, it can result in severe complications like facial nerve palsy, intracranial abscesses, and a further deterioration in hearing, necessitating emergency surgical intervention,” he says.

Diagnosis

Dr Vineet Narula, senior consultant, Max Smart Super Speciality at Saket, Delhi, says that diagnostic tests for cholesteatoma typically include a physical examination of the ear, otoscopy, or ear endoscopy to observe the ear canal and eardrum, and hearing tests (audiometry). “High-resolution imaging, like CT scans is used to provide a detailed view of the disease extent and inner ear’s structures,” he says.

Treatment

In a 2015 research conducted by Ashutosh Ganesh Pusalkar, at the Department of ENT Lilavati Hospital and Research Centre, it was revealed that the majority of individuals with cholesteatoma opt for surgical intervention. This is because cholesteatomas rarely resolve on their own; instead, they tend to persist and lead to complications. Hence, surgery is generally considered the most effective method for cholesteatoma removal and the prevention of associated issues.

Cholesteatoma calls for timely intervention, primarily through surgical means. “The type of surgery can range from a minimally invasive procedure like atticotomy with tympanoplasty to more extensive surgeries like modified radical mastoidectomy with tympanoplasty to clear the disease,” says Dr Narula. Surgery’s primary objective is to remove the abnormal tissue and prevent further harm to the ear. The choice of procedure depends on the extent of the condition.

However, the outcomes and recovery period can vary depending on the cases. “Recovery may involve post-operative care, antibiotics, and follow-up visits to monitor healing and hearing restoration,” says Dr Narula. A typical post-operative healing period lasts for four-six weeks, although it may differ depending on the extent of the surgery. For a smooth recovery, individuals should  follow specific instructions such as keeping the ear dry and avoiding cold and spicy foods.

Key takeaways for ear health

The key to mitigating the threat of cholesteatoma is awareness. Moreover, regular ear check-ups and prompt medical attention for any ear-related concerns are crucial. Dr Narula emphasises that early detection and treatment are pivotal in preventing complications. “It is essential to be aware of the signs and symptoms of ear problems and consult with an ENT specialist,” he says.

Cholesteatoma is a silent but potentially devastating condition that affects the ear’s delicate mechanisms. Prompt medical attention and appropriate surgical management can offer hope to those struggling with the condition.

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