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The ear is an important organ for the whole human body that aids in hearing and balance. Infection of the ear is one of the commonest conditions that cause morbidity. Middle ear infection is termed otitis media, and if it lasts for more than three months, it is called chronic otitis media. Chronic otitis media may either be safe or unsafe concerning its pathophysiological process. Cholesteatoma, known as the unsafe ear disease, is a non-cancerous growth in the middle ear. Its tissue composition consists of keratinising squamous epithelium, which expands to damage adjacent structures. Untreated cholesteatomas can cause hearing loss, dizziness, and may also lead to facial muscle paralysis.
This blog provides a comprehensive breakdown of cholesteatoma – the unsafe ear disease, its causes, indications for diagnosis, and management approaches.
Synopsis
What Is Cholesteatoma?
Cholesteatoma is an abnormal skin growth in the middle ear behind the eardrum. It usually results from persistent infections or negative middle ear pressure. Over time, the growth can enlarge, causing damage to the ear bones and also spreading out of the boundary of the ear. Research shows that cholesteatoma affects about 9 out of 100,000 people worldwide, with a higher risk in children. If left untreated, cholesteatoma can lead to permanent hearing loss, dizziness, or even brain infections like meningitis or brain abscess. Early diagnosis and treatment can prevent these complications. Surgery is often the only effective way to remove cholesteatomas and restore ear function.
Types of Cholesteatoma
Cholesteatoma can be of different types based on how it develops. Some occur at birth, while others form due to infections or ear injuries. Early detection can prevent severe complications. Here are the main types of cholesteatoma:
1. Congenital Cholesteatoma
This type develops before birth due to trapped skin cells in the middle ear. It is rare but can grow silently for years. Children often show symptoms like hearing loss or ear pressure.
2. Acquired Cholesteatoma
This occurs due to repeated ear infections or eardrum injuries. The growth expands over time, damaging nearby structures. It is more common in adults and requires early treatment to prevent hearing loss.
3. Primary and Secondary Cholesteatoma
Primary cholesteatoma forms due to poor Eustachian tube function, creating a vacuum that pulls the eardrum skin inward. Secondary cholesteatoma develops when eardrum injuries allow skin to enter the middle ear.
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Causes of Cholesteatoma
Cholesteatoma develops when skin cells grow abnormally in the middle ear. It often results from repeated infections, poor ventilation, or eardrum damage. If untreated, it can lead to severe complications like hearing loss and infections. Below are the leading causes of cholesteatoma:
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Chronic Ear Infections – Repeated infections can weaken the eardrum, allowing skin cells to accumulate abnormally.
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Eustachian Tube Dysfunction – Poor air pressure regulation in the middle ear creates a vacuum, pulling eardrum skin inward.
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Eardrum Perforation or Injury – Trauma or untreated ear infections can create openings for skin cells to invade the middle ear.
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Congenital Factors – Some babies are born with trapped skin cells in the middle ear, leading to cholesteatoma later in life.
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Symptoms to Watch For
Cholesteatoma symptoms may start mildly but worsen over time. Early detection is crucial to prevent serious complications like hearing loss or infections. If you notice persistent ear issues, seek medical attention immediately. Below are the key symptoms of cholesteatoma:
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Persistent Ear Discharge – A foul-smelling, sometimes bloody discharge may indicate an infection caused by cholesteatoma.
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Hearing Loss – As the growth expands, it damages middle ear structures, leading to progressive hearing loss.
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Ear Fullness or Pressure—You may feel constant pressure or blockage in the affected ear due to trapped skin and debris.
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Dizziness or Balance Issues – If cholesteatoma spreads to the inner ear, it can cause vertigo or balance disturbances.
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Facial Weakness or Pain – Severe cases may affect facial nerves, leading to muscle weakness or sharp pain around the ear.
Diagnosis
Cholesteatoma diagnosis requires a thorough ear examination. Early detection prevents severe complications like hearing loss or infections. Doctors use clinical evaluation and imaging tests to confirm the condition. Here are the main diagnostic methods for cholesteatoma:
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Otoscopy – Doctors use an otoscope to check for abnormal growth, eardrum retraction, or persistent ear discharge.
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Audiometry (Hearing Test) – This test measures hearing ability and detects hearing loss caused by cholesteatoma’s pressure on ear structures.
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CT Scan – A detailed scan helps assess the size and spread of cholesteatoma, especially if surgery is needed.
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MRI Scan – MRI helps distinguish cholesteatoma from other ear conditions, especially in recurrent cases.
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Treatment Options
Cholesteatoma requires medical treatment to prevent serious complications like hearing loss or infections. Surgery is the most effective option, but some cases need additional care to manage symptoms. Early intervention by an experienced ENT surgeon improves recovery. Here are the main treatment options for cholesteatoma:
Surgical Removal (Tympanomastoidectomy)
Cholesteatoma treatment focuses on surgical removal to prevent further damage to the middle ear and surrounding structures. The procedure usually involves Mastoidectomy (removal of the mastoid bone behind the ear) and Tympanoplasty (repair of the eardrum and middle ear bones). The surgical approach depends on the size and location of the condition.
Endoscopic Ear Surgery
In otology, minimally invasive approach using an endoscope is a significant advancement. At present, endoscopic ear surgery is being termed the primary modality in cases of middle ear cholesteatoma, offering a less invasive approach to treating various ear conditions. It is performed via the ear canal and it does not require post-aural scar or extensive tissue dissection and bone drilling. This technique is also known to lower the recurrence of the disease. It provides similar hearing improvement as the microscopic technique, but improved quality of life outcomes like better cosmesis, less post-operative pain and discomfort, and early return to normalcy.
Pre- and Post-Operative Care:
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Antibiotics and Ear Drops – These help control infections and reduce ear discharge before or after surgery.
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Hearing Rehabilitation – If the cholesteatoma has caused hearing loss, patients may need either hearing aids or reconstructive surgery of the ossicles to restore hearing function.
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Regular Monitoring – Follow-up check-ups and imaging scans help detect recurrence and ensure proper healing.
Conclusion
Preventing cholesteatoma involves maintaining good ear health. Treat ear infections early to avoid damaging the eardrum. Avoid using cotton swabs, which can push debris deeper. Keep ears dry to prevent bacterial growth. Consult a doctor immediately if you experience frequent ear infections or hearing issues. Regular ear checkups help detect problems early. In children, ear health is monitored closely, especially after infections. Early detection and treatment prevent complications like hearing loss or brain infections.
Book an appointment with our best doctor for Cholesteatoma treatment in Bangalore at Manipal Hospital Old Airport Road.
FAQ's
No, cholesteatoma does not heal naturally. To prevent serious complications, medical treatment, usually surgery, is required.
If it leads to infections or nerve damage, cholesteatoma may cause pain. Some people experience discomfort, while others feel pressure or fullness with reduced hearing function.
Yes, recurrence of unsafe ear disease is possible. Regular follow-ups and imaging tests help detect and manage regrowth early.
It usually affects one ear, but in rare cases, it can develop in both, especially in congenital cholesteatoma cases.
Yes, if it spreads to the inner ear, it can affect balance and cause dizziness or vertigo.
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