A very important piece of ear anatomy, the eardrum is a thin piece of tissue that separates the outer and middle ears from the inner ear. Cholesteatoma is an abnormal growth of skin cells that develops on or inside any part of this membrane. Left untreated, this sac of dead skin cells forms in a pocket in your middle ear and slowly gets larger, eventually filling your middle ear and mastoid bone, leading to hearing loss.

While it may resemble a cyst or a tumour, a cholesteatoma is not cancerous. It can, however, cause hearing loss, ear pain, and even infection if not treated, and may damage important ear structures like bones and the eardrum – so it’s important to attend regular hearing and ear checkups to catch and treat cholesteatoma early to preserve your ear health.

Cholesteatoma symptoms

People with cholesteatoma often experience a range of symptoms that can significantly impact their ear health and overall well-being, including hearing loss, recurrent ear infections, unpleasant-smelling discharge and ear pain.

Hearing loss is one of the primary cholesteatoma symptoms, though it may be quite mild initially. As the cholesteatoma grows, it can damage the delicate structures within the middle ear, which transmit sound vibrations to the brain. Left unchecked, the cholesteatoma may eventually fill the middle ear and mastoid bone, further contributing to hearing loss.

If you’ve noticed a gradual decline in your hearing or are having difficulties understanding and following conversations or participating in social activities, it’s essential to see your doctor to find out the cause.

Ear pain is another common sign of cholesteatoma. The growth of skin cells can cause pressure and discomfort in the ear, potentially leading to a deep, persistent ache. The pain may also worsen if there’s an infection – another of the common cholesteatoma symptoms.

In fact, recurrent ear infections can become a significant issue for those with cholesteatoma. The abnormal growth provides a haven for bacteria and debris to build up, leading to frequent infections, which can cause a bad-smelling, watery discharge, pain and even fever. Left untreated, chronic infections can damage the ear structures further and potentially spread to surrounding areas.

If you notice any of these symptoms, seek medical advice as soon as possible to determine the cause.


Cholesteatoma causes

There’s no single cholesteatoma cause, with both congenital and acquired factors playing a potential role in the development of this condition.

While cholesteatoma can be a birth defect, it usually forms due to weakness in the area caused by infection, injury or poor Eustachian tube function

The Eustachian tube normally equalises pressure within the ear, but when it’s not working as it should, this can result in a vacuum effect, drawing skin cells into the middle ear and leading to the growth of a cholesteatoma.

Chronic ear infections – often stemming from bacteria trapped within the cholesteatoma – can worsen the problem, making it clear that this issue is best attended to sooner rather than later. Getting regular ear and hearing checks and being aware of the symptoms can be crucial in early cholesteatoma diagnosis and treatment.

Diagnosing cholesteatoma

Cholesteatoma diagnosis requires a multi-pronged approach, including visual examinations, hearing tests and computer imaging, such as CT scans. Your doctor will start with an otoscopy – a visual inspection of the eardrum – as the first step in diagnosing cholesteatoma. And while that might sound technical, it’s a procedure many of us have experienced before during regular check-ups with a GP. An otoscope is simply an instrument with a light and a magnifying glass that the doctor places at the ear's opening to see inside.

Your doctor or healthcare professional may also conduct an in-depth hearing test to assess the extent of hearing loss caused by the growth's impact on the middle ear and may refer you to an ear, nose and throat specialist for a CT scan and to discuss treatment.

Imaging techniques like CT scans provide more detailed visuals of the ear's internal structures, which helps in accurate diagnosis. Early detection plays a major role in preventing complications, including hearing loss, damage to important ear structures and potential spread of infections, and also ensures the right treatment can be administered promptly – so if you’re experiencing any of the above cholesteatoma symptoms, book in to see your GP today.


Cholesteatoma surgery

While antibiotics and regular cleaning can help keep infection and smelly discharge at bay, surgery is the only way to remove a cholesteatoma. Cholesteatoma surgery is performed under a general anaesthetic by an ear, nose, and throat (ENT) surgeon and usually takes around two to three hours. The aims of cholesteatoma surgery are threefold: to remove the sac of skin, repair any damage already done to the ear’s delicate structures and restore hearing as best as possible.

Cholesteatoma surgery typically involves two different procedures – tympanoplasty and mastoidectomy. Tympanoplasty focuses on repairing the eardrum, middle ear bones and other affected structures to restore hearing function. Essentially, it is the surgical reconstruction of the middle ear.

Mastoidectomy, on the other hand, involves removing any infected bone, as well as the sac of skin, to eliminate the source of infection and prevent its spread. It also involves repairing any holes in the eardrum.

While you should be able to go home the day after surgery, it can take up to three weeks before people who’ve had these procedures get back to work, and proper postoperative care is essential for maintaining ear health.

Patients must follow post-surgery instructions carefully, which may include avoiding water exposure to the ear, taking medications and attending follow-up appointments. Regular check-ups are vital to prevent recurrence, which can happen if any of the cholesteatoma is left behind. It’s important to communicate with your specialist, and if you have any concerns, get in touch with them.

Left unchecked, cholesteatoma poses risks of hearing loss, infections and pain, and prompt diagnosis through visual exams, hearing tests and CT scans is vital. Though non-cancerous, cholesteatoma’s impact on ear structures means the need for timely treatment is essential, and early intervention is key to preserving not only your ear health but also your hearing.

When to seek help

If you’ve noticed any changes in your hearing or are concerned about your ear health, make an appointment with your nearest Bay Audiology clinic today.

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