Overview: What is a cholesteatoma?
A cholesteatoma is a benign growth in the ear, more precisely in the middle ear or behind the eardrum. In a healthy ear, the outer ear canal is lined with skin cells and the middle ear is covered with mucous membrane cells. Between them is a thin membrane that separates the two areas: the eardrum. If the eardrum is damaged, skin cells from the ear canal can grow into the middle ear and spread there. Experts refer to these onion-skin-like growths as cholesteatoma. In principle, these growths are benign and have nothing to do with cancer. However, bacteria can multiply particularly well at this point, which favors the development of a chronic middle ear infection.
Cholesteatoma can also damage the small auditory ossicles, the malleus, incus and stapes. These are located in the middle ear and are responsible for transmitting vibrations from the outside to the inner ear. Cholesteatoma can therefore cause hearing loss, among other things, in those affected.
In addition to hearing loss, an untreated cholesteatoma can lead to other serious complications, such as blood poisoning (sepsis), a brain abscess or meningitis, dizziness or deafness.
Cholesteatoma – frequency and age
Overall, the disease occurs only very rarely. On average, nine out of 100,000 people are diagnosed with cholesteatoma each year. Children between the ages of five and 15 are most frequently affected.
Cholesteatoma: Causes
The cause of a cholesteatoma is damage to the eardrum, which allows skin cells (and bacteria) to enter the middle ear. There are two types of cholesteatoma, depending on how the injury occurred.
There are congenital and acquired cholesteatomas.
- Congenital cholesteatomas are very rare. They occur when remnants of skin cells remain in the middle ear during the development of the embryo. The eardrum is not damaged in this case.
- In acquired cholesteatomas, the skin cells only reach the middle ear later. Experts distinguish between the primary and secondary cholesteatoma.
Primary cholesteatoma
Most frequently, a cholesteatoma develops primarily from a so-called retraction pocket. A retraction pocket occurs when the eustachian tube is blocked and the middle ear is no longer properly ventilated as a result. Normally, the Eustachian tube serves as a kind of tunnel between the middle ear and the throat. If the middle ear is no longer permanently ventilated, negative pressure is created, which can cause the eardrum to retract (hence the term retraction pocket) or even rupture. Skin remnants gradually collect in the retraction pocket. In addition, bacteria can multiply quickly in this pocket and cause a chronic middle ear infection.
Secondary cholesteatoma
A secondary cholesteatoma is when the eardrum has already been damaged beforehand. The actual reason for this may be an external injury to the eardrum or repeated middle ear infections. Bacteria and skin cells enter the middle ear through the hole in the eardrum, causing cholesteatoma.
Symptoms: Cholesteatoma often resembles a middle ear infection
Cholesteatoma often causes no symptoms, especially in the early stages. The accumulation of skin cells in the middle ear usually goes completely unnoticed. It is only when the affected area becomes inflamed that symptoms similar to those of otitis media occur.
Possible symptoms are
- foul-smelling secretions and/or pus draining from the ear
- Stinging earache,
- Pressure pain,
- general feeling of illness,
- Hearing loss
- Headache
- Sometimes fever
Cholesteatoma: Diagnosis with us
In many cases, a cholesteatoma can be diagnosed relatively reliably on an outpatient basis. Using an ear microscopy, we first examine whether the eardrum is damaged and the middle ear is inflamed and how far the cholesteatoma has progressed. Under an ear microscope, the cholesteatoma looks like a whitish-yellow crust, as the whitish-yellow keratin is contained in skin cells, among other things.
It is more difficult if the ear is acutely inflamed and oozing. We may then have to suction the secretion out of the ear canal first. In children, this is often only possible under anesthesia.
We can also use special tests to check your hearing and sense of balance. With a computer tomography (CT) scan, we can determine exactly where the growth is located and whether the ossicles are already affected. Magnetic resonance imaging (MRI ) can also provide further information about the disease.
When to see a doctor?
If you suspect an inflammation of the middle ear or a cholesteatoma, you should always consult us. Especially if you have severe headaches or neck pain, you need acute medical help. In rare cases, this could be an indication of meningitis or an injury to the facial nerves. This can lead to numbness in the face or drooping corners of the mouth. You should also consult us immediately if you experience such symptoms of facial paralysis.
Cholesteatoma: What you can do yourself
A cholesteatoma cannot be avoided with certainty. Nevertheless, there are some things you should look out for if you have pain in your ears or other signs of cholesteatoma.
- Avoid getting water in your ear when swimming or showering.
- Do not use cotton buds in the ear canal.
- Do not poke your ear.
In general, as soon as the first symptoms of a cholesteatoma appear, you should definitely visit us.