What is the treatment for cholesteatoma?
A cholesteatoma does not have a blood supply so taking antibiotics by mouth will not work at all because the antibiotics can't get into it. Antibiotic ear drops can clear away any infection around the cholesteatoma but will not treat the actual problem. Many people will have had antibiotic ear drops prescribed to them without success, before they are diagnosed with a cholesteatoma.
The treatment is done by an ear specialist (an ENT doctor) and usually consists of an operation under a general anaesthetic. The aim of the surgery is to remove the tiny balls of cholesteatoma and then to clear out part of the middle ear so air can circulate around better. This will hopefully stop the cholesteatoma coming back.
There are different types of surgery that can be done and a specialist ear doctor will advise you which operation is best. The most common is called a 'combined approach tympanoplasty' where the damaged part of the eardrum is removed and the bone at the back of the ear, the mastoid, is cleared out.
If the patient is not fit for surgery (for example, if they are very old or frail or have other serious medical conditions) then regular visits to an ear specialist will be recommended. This is so the specialist can suction out any tiny bits of wax or debris deep in the ear that can contribute to a cholesteatoma. This will not solve the problem but can keep it from getting worse.
What are the possible complications and why is treating it important?
Untreated, a cholesteatoma will slowly grow and expand. As it grows it can eat into (erode) and destroy anything in its path.
Therefore, possible complications that may develop over time include:
- Damage and eventual destruction of the tiny bones of the ear (the ossicles). If these are damaged, permanent deafness can occur.
- Damage to the mastoid bone. This is the thick bony lump you can feel behind the ear. The mastoid bone is normally filled with pockets of air (a bit like a honeycomb). Cholesteatoma can grow into the mastoid bone, causing infection and destroying it.
- Damage to the cochlea and other structures in the inner ear. This can cause permanent deafness on that side, and/or dizziness and balance problems.
- Damage to nearby nerves travelling to the face. This can cause weakness (paralysis) of some of the facial muscles.
- Cholesteatoma is often infected and this infection can spread to nearby body parts. In rare cases a cholesteatoma can erode through the skull next to the ear and into the brain. As a result of spreading infection, conditions such as meningitis and brain abscess can develop. These conditions can cause death.
Is any follow-up required?
Unfortunately, if you have had a cholesteatoma, you will need to be followed up for life in an ENT clinic.
You will also need to have your ears cleaned regularly at the clinic to remove wax and any dirt that has accumulated. The specialist will need to ensure that the cholesteatoma has not returned.
If the ear starts discharging again, further surgery may be required. MRI scans are increasingly being used to replace the need for further check-up surgery.
What is the outlook?
This depends on how much damage has been caused by the cholesteatoma by the time it is found and treated. It is also affected by whether any complications such as meningitis or deafness have occurred. The earlier surgery is done, and attending for regular follow-up, the better the chance of a good outcome.
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