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Cholesteatoma
Definition
Cholesteatoma is a type of skin cyst located in the middle ear and skull bone (mastoid).
Causes
Cholesteatoma can be a birth defect (congenital), but it more commonly occurs as a complication of chronic ear infection.
Poor function in the eustachian tube leads to negative pressure in the middle ear. This pulls a part of the eardrum (tympanic membrane) into the middle ear, creating a pocket or cyst that fills with old skin cells and other waste material. The cyst can become infected. The cyst may get bigger and break down some of the middle ear bones or other structures of the ear, affecting hearing, balance, and possibly function of the facial muscles.
Symptoms
- Dizziness
- Drainage from the ear
- Hearing loss in one ear
Exams and Tests
An ear exam may show a pocket or perforation (opening) in the eardrum, often with drainage. The deposit of old skin cells may be visible with a microscope or an otoscope, a special instrument to view the ear. Sometimes a mass of blood vessels may be seen in the ear.
The following tests may be performed to rule out other causes of dizziness.
- CT scan
- Electronystagmography
Treatment
Surgery is needed to remove the cyst.
Outlook (Prognosis)
Cholesteatomas usually continue to grow if not removed. Surgery usually works, but you may occasionally need the ear cleaned by a health care provider. Additional surgery may be needed if the cholesteatoma comes back.
Possible Complications
- Brain abscess
- Deafness in one ear
- Dizziness (vertigo)
- Erosion into the facial nerve (causing facial paralysis)
- Labyrinthitis
- Meningitis
- Persistent ear drainage
- Spread of the cyst into the brain
When to Contact a Medical Professional
Call your health care provider if ear pain, drainage from the ear, or other symptoms occur or worsen, or if hearing loss occurs.
Prevention
Prompt and complete treatment of chronic ear infection may help to prevent some cases of cholesteatoma.
References
Chole RA, Sudhoff HH. Chronic otitis media, mastoiditis, and petrositis. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 139.
O’Handley JG, Tobin EJ, Shah AR. Otorhinolaryngology. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 19.
Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Seth Schwartz, MD, MPH, Otolaryngologist, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
