Cholesteatoma and Chronic Ear Disease

Cholesteatoma is a term applied to an invasive process of the middle ear. In essence it is the growth of skin into areas of the ear where it is not usually found. In most cases it is related to long standing eustachian tube dysfunction creating severe negative pressure within the ear.

Once this has developed, the cholesteatoma can cause progressive destruction of the ossicles and thus hearing loss, and more rarely inner ear damage with balance affected, facial nerve damage and finally invasion into cranial cavity.

The usual symptoms are long standing discharge  and hearing loss, although it can be essentially asymptomatic. Normally there is a long history of ear problems, extending to early childhood.

Once identified surgery is usually required, although the agressiveness of this disease is variable. The extent of disease will dictate the extent of surgery. In early cases an endoscopic approach is appropriate. As the disease becomes more extensive the invasive of surgery increase. Various types of mastoidectomy are employed broadly divided into canal wall up or canal wall down (modified radical) mastoidectomies.

In general terms the aim of treatment is create a safe, dry ear, with attempts to improve hearing an important but secondary consideration.

Early right attic cholesteatoma

Bilateral cholesteatoma treated with intact canal wall mastoidectomies with reconstruction of the attic

Modified radical mastoidectomy: the treatment for more extensive cholesteatoma where the ear canal and the mastoid air cell system are joined to create a ‘mastoid bowl’.