Medical Q&As

Cholesteatoma - please explain?

I've recently been diagnosed with a cholesteatoma in one of my ears. Over the years I've had 3 operations; one to fit a grommet, and 2 to remove cysts. I am now on a waiting list for the past 6 to 8 months in order to have the cholesteatoma treated. I just need more information on this condition.

A cholesteatoma is a benign growth of skin that can occur in the middle ear or the mastoid bone, which is part of the skull and located just behind the ear. The condition can sometimes be present at birth but more usually it is a result of perforation of the eardrum associated with infection or it can happen as result of a malfunctioning Eustachian tube. I deduce from your question that you have had ongoing middle ear infections associated with perforation of the drum. In that scenario the layer of cells on the outer surface of the eardrum can grow through the perforation and into the middle ear. Some of these cells eventually die and accumulate in the middle ear from which they cannot be expelled. As this mass of dead cells increases in size various enzymes can leak from the mass, which in turn can cause erosion of bone. This can cause destruction of the ossicles, which are the tiny delicate bones in the middle ear and the erosion can extend further and damage the mastoid bone. Infection can then arise, which can extend from the ear into the surrounding structures giving rise to further damage. Surgery for cholesteatoma involves removal of the mass and may also involve reconstruction of the ossicles and eardrum. Sometimes it might be possible to perform such surgery in a comprehensive “one-off” procedure but if the cholesteatoma were extensive a series of operations might be needed to remove it. Surgery of the middle ear is a very delicate undertaking and involves the use of micro-dissection techniques, which require the use of a surgical microscope. It is important to be aware that cholesteatoma can recur and all people with this condition require follow up at regular intervals in order to outrule recurrence.