Cholesteatoma: Symptoms, Diagnosis, and Treatment

Cholesteatoma is a benign cyst that is located in the ear. Although, his demeanor may be locally malignant Due to the invasion of the surrounding tissues where we find noble structures that can suffer irreversible injuries, such as facial paralysis, and mastoiditis.

Cholesteatoma can appear in the birth (congenital or primary) or do it at older ages and as a consequence of another secondary process, for example, after the chronification of one. The neonates with craniofacial malformations and / or genetic alterations are predisposed to develop cholesteatomas.

Symptoms of a cholesteatoma

Cholesteatoma can cause different symptom, the most relevant being:

• Hearing loss (deafness)
• Balance disturbance (Vertigo)
• Rupture of the chain of the ossicles of the middle ear

Others less frequent symptoms They would be the feeling of occupation in the external auditory canal, the pressure or pain inside the canal or the ringing in the ear (tinnitus).

In the case of children, the most frequent symptoms are hearing loss and otorrhea (suppuration through the external auditory canal that is usually due to perforation of the tympanic membrane by an infection or inflammation originating in the middle ear) of repetition resistant to treatment.

The most common cause is Eustachian tube dysfunction

The most frequent cause associated with the appearance of a secondary cholesteatoma is the Eustachian tube dysfunction. This dysfunction causes an increase in negative pressure in the middle ear and drags the tympanic membrane into the middle ear, creating a cul-de-sac where detritus substances (cell debris) can accumulate and whose content can become superinfected.

This can affect hearing, balance and even facial gestures due to a nerve injury (facial nerve) that affects the facial muscles.

How is it diagnosed

Diagnosis is made by a physical exploration. The otoscopy allows visualization of the tympanic membrane and, in the case of cholesteatoma, a mass or opacity is visualized behind the tympanic membrane that suggests accumulation.

In this case, the request for a complementary test, specifically of the one that allows to visualize the size, characteristics and location of the lesion, as well as its relationship with neighboring structures. It would be revealed by conductive hearing loss due to involvement of the ossicular chain.

Is there a treatment for cholesteatoma?

The initial approach consists of the eradication of the possible infectious process associated with the process. A topical treatment (in the form of ear drops) or orally.

Although, the definitive treatment is surgical. It is performed in the operating room under general anesthesia and it must be carried out as soon as possible since the size can increase causing irreversible injuries. In case of affectation of noble structures A monitor should be used to guide the surgeon regarding the proximity of the nerve during surgery to avoid injury.

After the first cholesteatoma resection surgery, the rest of the associated lesions should be addressed, such as hearing loss due to affectation of the ossicular chain that may require the placement of a.

In view of large lesions it may be necessary to perform more than one surgical act to achieve resection of the entire lesion and associated lesions. Also, in a small percentage of cases a recurrence of the cholesteatoma may appear which should be treated again with surgery.

Some possible serious complications Associated with the evolution of cholesteatoma may be brain abscess, facial nerve involvement or meningitis. Therefore, its detection is important and, even more, its prevention by means of the eradication treatment of any infectious process of the ear.

• Cholesteatoma is a benign cyst located in the middle ear.
• Cholesteatoma can appear at birth (congenital or primary) or at older ages and as a consequence of another process (secondary), for example, after the chronification of a middle ear infection.
• The definitive treatment is surgical.

Family Medicine Specialist.