 Ear infections due to cholesteatoma
 A history of recurring ear infections after colds or after swimming, require the ear to be examined regularly for cholesteatoma.
Cholesteatoma is defined as a cyst located in the middle ear. Cholesteatoma can be a congenital defect, but it more commonly occurs as a complication of chronic ear infections. Long-term swelling and disfunction of the eustachian tube can lead to chronic negative pressure in the middle ear. This negative pressure pulls a portion of the eardrum (tympanic membrane) inward, creating a sac or cyst. This cyst then fills with old skin cells and other debris, becoming chronically infected.
The bone behind the ear is called the mastoid bone, and it connects to the middle ear. In a healthy ear, it is filled with air; however, in cholesteatoma, this area becomes filled with irritated mucous membranes and the cholesteatoma itself often grows into this bone. The cyst typically continues to expand and may even erode the mastoid bone and middle ear bones. Meningitis, dizziness and facial muscle paralysis are rare but can result from continued cholesteatoma growth.
A perforation of the ear drum will generally heal without surgery. In some cases, however, instead of normal healing, the skin of the ear drum can grow through the hole into the middle ear. If infection is present, the skin will continue to grow into the middle ear and will become a tumour of the ear termed a cholesteatoma. Cholesteatomas are NOT a form of cancer. They are benign tumours. As they grow, they can look like an onion peel of white skin formed into a ball. They can destroy the bones of hearing as they grow, especially when the ear is infected or if water gets into the middle ear with other infections.
A history of recurring ear infections after colds, or after swimming, require the ear to be examined regularly for this condition.
Cholesteatomas actively erode bone because they contain enzymes which are activated by moisture. In time, cholesteatomas will eventually erode the bone leading into the inner ear. This can cause nerve loss and deafness as well as severe imbalance and dizziness. The thin plate of bone that separates the roof of the ear from the brain can also be eroded by cholesteatomas. This exposes the covering of the brain. In extreme situations, it can lead to brain infection and other severe
complications.
Cholesteatoma is a serious condition and, when diagnosed, requires prompt treatment. Medical treatment concentrates on drying the infection within the ear. Antibiotics, given both by mouth and drops in the ear, combined with weekly cleaning of the ear under the surgical microscope, can clear up the infection. Polyps (growth of inflamed tissue) are often present in the ear with
cholesteatoma.
The polyps can shrink or may have to be surgically removed before the infection will clear up. With children, removal of polyps may have to be done under anaesthesia in the hospital. In some cases, intravenous antibiotics may have to be given to clear up the infection.
A (CAT) CT scan is obtained by the ear surgeon to determine how much the cholesteatoma has spread in the ear. The bone behind the ear is called the mastoid bone. It connects to the middle ear. In a healthy ear, it is filled with air. In most cases of cholesteatoma, the mastoid bone is filled with irritated mucous membranes and cholesteatoma itself often grows into this bone.
The CAT scan will guide the ear surgeon as to how far the cholesteatoma has grown and whether it has eroded into the inner ear or brain. The CAT scan will also indicate the degree to which bones of hearing have been eroded. Once infection is cleared up and the ear is dry, a decision regarding surgery to remove the cholesteatoma can be made. Unless the person with cholesteatoma is extremely ill with other medical conditions, microsurgery and removal of the cholesteatoma is recommended. The ear surgeon then has to plan the type of surgery necessary to remove the tumour completely. For further information and registrations for surgery one can call 2641 1444 / 2641 1987 / 2641 1612.
Signs & symptoms
Initially, the ear may drain, sometimes with a foul odour. As the cholesteatoma pouch or sac enlarges, it can cause a full feeling or pressure in the ear, along with hearing loss. (An ache behind or in the ear, especially at night, may cause significant discomfort.) Dizziness, or muscle weakness on one side of the face (the side of the infected ear) can also occur. Any, or all, of these symptoms are good reasons to seek medical evaluation. Cholesteatoma may be prevented by prompt treatment of ear infections.
Cholesteatoma diagnosis
Inspection of the ear may show a pocket or perforation (opening) in the eardrum, often with drainage. The deposit of old skin cells may be visible.
Diagnostic tests
Audiologic testing helps to determine the presence and extent of hearing loss. Tests may be performed to rule out other causes of dizziness. A CAT scan will guide the ear surgeon as to how far the cholesteatoma has grown and whether it has eroded into the inner ear or brain. The CAT scan will also indicate which bones of hearing have been eroded.
Treatment
The only known treatment for cholesteatoma is removal of the cyst. Cholesteatomas usually continue to grow if not removed. Surgical treatment is extremely effective. With greater and greater technological advances, the results have consistently been improving.
At the KKR ENT Hospital & Research Institute, the results of surgery for cholesteatoma now approach 100 per cent. The surgical results achieved are directly proportionate to the experience of the surgeon and the KKR ENT Hospital & Research Institute, being the leading ear hospital in the country, offers the best results for this kind of surgery.
Cholesteatoma complications as result of surgery:
Possible surgical complications include, but are not limited to: deafness in one ear, dizziness, persistent ear drainage, erosion into the facial nerve (causing facial paralysis), leakage of cerebral spinal fluid, labyrinthitis, vertigo, meningitis, and brain abscess. All these complications are now reduced to a bare minimum because better surgical techniques are available.
For further details, contact: 2440 1436 / 98412 55885 / 98656 52236.
Dr Ravi Ramalingam
Leading ENT Surgeon & Managing Director,
KKR ENT Hospital.
|
