Cholesteatoma: Symptoms and Treatment

Cholesteatoma of the ear is a tumor-like neoplasm in the middle ear cavity, which consists of the depleted epithelium and the cholesterol crystals. The treatment of this disease, in most cases, is surgical. In rare cases and only at the initial stage of the development of the disease, sanitation of the above-drum cavity can be used to remove the encapsulated tumor.



Etiology

Cholesteatoma of the middle ear can be congenital, which is due to various embryonic disorders. To the acquired etiologic factors of development of cholesteatoma of an ear it is necessary to carry:


  • chronic suppurative otitis media (90% of cases are caused by this disease)
  • inflammatory or infectious diseases in the ear canal
  • mechanical damage to the hearing;
  • injury to the tympanic membrane.

In rare cases, the etiology of this otolaryngological disease can not be established.

Classification

According to the origin of these types of cholesteatoma of the ear:


  1. congenital or true — localized in the pyramid of the temporal bone, less often in the lateral cistern or ventricles of the brain
  2. acquired or false — as a consequence of the above pathological factors.

Localization distinguishes such types of this disease:


  • the brain;
  • middle ear
  • the temporal bone.

The most unfavorable predictions are observed in the formation of cholesteatoma in the brain and temporal bone, since there is a high probability of infection of the blood.

Pathogenesis

Clinicians identify two mechanisms of tumor formation:


  1. ingrowth of the epithelium of the external auditory tube into the middle ear cavity
  2. due to certain etiological factors, the lumen of the auditory canal narrows, which provokes the development of the inflammatory process.

Regardless of the underlying cause and pathogenesis of the disease, treatment should be carried out immediately to prevent the development of complications.

Symptoms

At the initial stage of development, a pathological process can occur without symptoms, which is due to the small size of the lesion. As it sprouts, the following symptoms may appear:


  • hearing loss
  • foreign body sensation in the ear canal
  • pains in the ear of a shooting, bursting character, which only increase as the tumor grows;
  • headaches that can be caused by the development of a purulent process or intracranial complications
  • Allocations that can form crusts. As the disease worsens, they become more abundant, have a sharp fetid odor, may contain impurities of blood.

In case of attachment of the bacterial process, the general clinical picture can be supplemented by such signs:


  1. elevated body temperature;
  2. nausea, often with vomiting,
  3. weakness, drowsiness;
  4. dizziness.

In such a clinical picture, medical attention should be sought immediately, since sepsis may develop, which is life-threatening.

Diagnostics

Initially, a physical examination of the patient with clarification of complaints, an anamnesis of the disease and the life of the patient. To establish a definitive diagnosis and determine the type of tumor formation, such laboratory-instrumental examination methods are conducted:


  • otoscopy;
  • determining the patency of the ear canal
  • radiograph of the skull;
  • CT;
  • MRI
  • Audiometry
  • Threshold audiometry
  • otoacoustic emissions
  • Vestibulometry
  • Stabilography

If suspected of inflammation of the cerebral membranes can hold a lumbar puncture. In addition to examination by an otolaryngologist, consultation with a neurosurgeon and a neurologist may be required.




Treatment

Cholesteatomy removal is most often performed with the help of an operation. Conservative treatment is possible only if the tumor is small and located in the above-drum space. In such cases, the «leaching» of the tumor with an isotonic solution is carried out.

With inefficiency or inexpediency of conservative treatment, the operation is performed:


  1. Mastoidotomy
  2. Labyrinthectomy
  3. tympanoplasty;
  4. Translabyrinth opening of the temporal bone pyramid

Any kind of operation is carried out in several stages — initially the tumor is removed and the cavity is sanitized to prevent the development of infectious processes. Further reconstruction of damaged auditory ossicles and restoration of the integrity of the tympanic membrane are performed.

It should be noted that if the patient is diagnosed as having a congenital cholesteatoma, the operation is administered immediately — without prior conservative treatment.

If treatment is started in time, significant complications can be avoided and the hearing will be fully restored.

Possible complications

This disease can cause such complications:


  • epitimpanitis with cholesteatoma develops
  • destruction of the walls of the bone canal, which leads to paresis of the facial nerve
  • meningoencephalitis
  • sepsis
  • Hearing loss
  • total hearing loss.

You can avoid such consequences if you seek timely medical help.

Prevention




Since in most cases, the middle ear cholesteatoma is due to otolaryngological diseases, it is necessary to prevent these diseases. It is also necessary to regularly and correctly carry out hygienic procedures for cleaning the ear canal, timely treat infectious and inflammatory diseases. At the first symptoms you need to go to the doctor, and not to self-medicate.