Cholesteatoma (pronounced coal-est-e-uh-toe-ma) is a destructive, abnormal tissue growth that typically occurs in the middle ear. Left untreated, cholesteatoma can eat into nearby bones, resulting in nerve deterioration, deafness, imbalance, and vertigo. Because of it’s potential to cause central nervous system complications by damaging the brain and/or spinal cord, it is a potentially fatal disease.
What Causes A Cholesteatoma?
There are two main types of cholesteatomas: acquired and congenital (congenital: existing at birth). Acquired cholesteatomas are far more common, and are caused a retracted or damaged eardrum.
With eardrum retractions, the Eustachian tube (the tube that connects the back of the nose to the middle ear) is dysfunctional and doesn’t let enough air into the middle ear. This causes negative pressure behind the eardrum and forces it to retract. Long term retraction causes the eardrum to erode the ear canal, forming a deep pocket where a cholesteatoma can form. In a healthy ear, the skin of the eardrum migrates slowly outwards, thereby shedding dead skin cells much like a conveyor belt. However, in an unhealthy ear, this conveyor belt stops, and layer after layer of skin cells begin to buildup, thereby forming a cholesteatoma.
The second type of acquired cholesteatomas are those due a damaged eardrum. Squamous epithelium (skin cells) is introduced into the middle ear through a torn or perforated eardrum. This is usually due to repeated ear infections, but any type of traumatic injury can create these conditions (an explosion, for example). With the ear unable to properly shed these tissues, a cholesteatoma forms.
Congenital cholesteatomas are rare, but they do occur in some individuals. Squamous epithilium becomes “trapped” in the middle ear during development in the womb, which later progresses to a cholesteatoma after birth. Congenital cholesteatomas can be harder to detect because they occur behind a perfectly healthy eardrum.
Life After Surgery
Since cholesteatomas are almost always located in the ear, by far the most common side effect is permanent, moderate hearing loss. The amount of hearing loss will depend on how long the cholesteatoma went untreated, due to it’s ability to erode the sensitive sound receptors in the inner ear. They tend to progress faster in children, especially in the presence of chronic ear infections. Quick detection and treatment is critical to minimize potential long term side effects.