Cholesteatoma is an abnormal collection of skin cells behind the ear drum in the middle ear space, which may eventually result in destruction to the bony structures in the middle ear, such as the middle ear bones (ossicles), the hearing organ (cochlear), the balance organ (labyrinth), the base of the skull (tegmen tympani) and even the bony covering of the facial nerve. Uncommonly, cholesteatoma can also occur in the deeper structures such as the petrous apex and the cerebellopontine angle.
The most common presentation of cholesteatoma is ear discharge (otorrhoea) and hearing loss. Other symptoms would include ringing in the ear (tinnitus), a painful ear (otalgia) and giddiness. Rarely, you may also experience headaches. You may also have no symptoms and it may also be incidentally picked up during a routine ear examination during a doctor’s visit for a separate problem.
Cholesteatoma may either be congenital (i.e. you are born with it) or acquired later in life.
Risks factors for acquired cholesteatoma include previous infection, a hole in the ear drum (tympanic membrane perforation) and previous otologic surgeries. Other risk factors include a poorly functioning Eustachian tube which results in negative pressure in the middle ear and a resultant retracted ear drum
A diagnosis is usually made on careful inspection of the ear by a doctor. There will be tell-tale signs of cholesteatoma. If cholesteatoma is suspected, the ENT doctor would then usually proceed with an audiological test to determine the degree of hearing loss, and also order a CT scan to determine the extent of the disease.
Surgery is often required for the treatment of cholesteatoma. If left untreated, the destructive and expansile nature of this condition can result in destruction to the bony structures in the middle ear, such as the middle ear bones (ossicles) and the hearing organ (cochlear) both resulting in hearing loss, the balance organ (labyrinth) to cause giddiness, the bony covering of the facial nerve to cause facial weakness and even the base of the skull (tegmen tympani) to cause involvement of the brain. If left untreated it can also be infected, causing pain, discharge and fever.
After doing the necessary investigations such as the audiological test and CT scans, the doctor will bring you through the process of the surgery. The extent of surgery is often dependent of the extent of the disease and it is individualized to the patient (see webpage on "Mastoidectomy"). It is done under General Anaesthesia.
You will often be discharged from the hospital after a night’s stay after your operation. It is important that you observe water precautions after surgery and prevent water from entering the operated ear after the surgery, especially when showering. Also, avoid heavy lifting and straining / sneezing for at least 1 month after your surgery. Any external scars should also be taken care of. An ointment will usually be prescribed for you to apply on the external scar. Ear drops will also be prescribed for you to apply into your ear. Rest assured that the doctor and the nursing team will teach you the wound care and give you specific instructions prior to your discharge. A doctor’s appointment will usually be fixed for you about one week after your discharge to review your wound.
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