The name, Cholesteatoma, is a misnomer. Previously it was thought that cholesterol was a major part of the condition. Actually, the condition consists of skin-like tissue growing in the middle ear where no skin belongs.
Is Cholesteatoma common?
It is not common. But it is very commonly seen In the office of someone who does a considerable amount of ear care. In our hospital it is very commonly seen.
What damage does Cholesteatoma do in the ear?
The disease can significantly destroy the hearing bones of the ear. Over time, the cholesteatoma can cause considerable problems. The significant time frame is years and decades, usually not weeks and months . Not only are the hearing bones being destroyed, but other tissues can become involved such as the facial nerve (which can cause paralysis), the inner ear(which can cause deafness and/or dizziness), the brain (as a cause of brain abscess or meningitis), or the neck (the site of an abscess).
What is the treatment for Cholesteatoma?
Cholesteatoma can only be treated with surgery. It is important to know that the surgery might not be a one-stage treatment since cholesteatoma is a condition that requires long-term monitoring.
What type of surgery is needed?
The traditional surgical approach to cholesteatoma is to open up the small spaces among the middle ear, the ear canal and the mastoid (the bump in the skull that you feel behind the ear). This amount of surgery is needed because of the extensive destruction of tissue from the disease. This is called a canal wall down mastoidectomy.
Another procedure attempts to maintain more normal anatomy. With this surgery, the ear canal wall is maintained (canal wall up mastoidectomy). This operation is not applicable for all patients however.
A third procedure makes a window between the mastoid and the ear canal wall to allow visualization but then reconstruction of the wall at the end of the operation recreates an intact ear canal wall (canal wall window mastoidectomy). It should be noted that cholesteatoma frequently recurs. Sometimes a second surgery is even planned, before the first operation occurs.
What are the goals of the surgery?
We attempt to eliminate the disease and to reconstruct the ear in a way to try to prevent re-accumulation of disease. Additionally, we work to gain the maximum hearing possible under the circumstances, depending on the location of the disease and the destruction that has already occurred. It is also our goal to provide an ear repair for the patient, that will not be problematic with water exposure and to provide as much of a normal appearance to the ear as is possible. Accomplishing those tasks is not always possible. But often, many of the objectives can be accomplished. We are particularly sensitive to hearing needs in children because the ear must serve them for decades.
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