Cholesteatoma

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Cholesteatoma is a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process.

Contents

Signs and symptoms

The patient may have a recurrent ear discharge. Granulation tissue and a discharge (through a marginal perforation of the ear drum) may be seen on examination. A cholesteatoma cyst consists of desquamating (peeling) layers of scaly or keratinised (horny) layers of epithelium, which may also contain cholesterol crystals. Often the debris is infected with Pseudomonas aeruginosa.

If untreated, a cholesteatoma can eat into the three small bones located in the middle ear (the malleus, incus and stapes, collectively called ossicles), which can result in nerve deterioration, deafness, imbalance and vertigo. It can also affect and erode, through the enzymes it produces, the thin bone structure that isolates the top of the ear from the brain, as well as lay the covering of the brain open to infection with serious complications.

Both the acquired as well as the congenital types of the disease can affect the facial nerve that extends from the brain to the face and passes through the inner and middle ear and leaves at the anterior tip of the mastoid bone, and then rises to the front of the ear and extends into the upper and lower face.

A history of ear infection or flooding of the ear during swimming should be taken seriously and investigated as cholesteatoma should be considered a possible outcome.

Common symptoms of cholesteatoma may include: Hearing loss, mucopurulent discharge from the ear (usually brown/yellow) with a strong odor, bleeding from the ear, dizziness, vertigo, balance disruption, ear ache, headaches or tinnitus. There can also be facial nerve weakness.

Causes

There are two types: congenital and acquired. Acquired cholesteatomas, which are more common, can be caused by a tear or retraction of the ear drum.

Cholesteatoma is an epidermoid cyst of the middle ear and/or mastoid. It developed as a consequence of eustachian tube dysfunction and chronic otitis media, secondary to retraction of squameous elements of the tympanic membrane into the middle ear space. Those squamous elements cause bone destruction secondary to its expanding nature and through enzymatic destruction [1].

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