Cholesteatomas are benign, skin-lined sacks that form behind the eardrum in the middle ear. They can form when the eardrum gets sucked into deep pockets due to long term negative pressure in the middle ear. They can also be caused by surgery on the eardrum. In very rare instances, individuals are born with them.
Even though it is benign (not cancerous) it is a dangerous condition. These sacks of skin grow over time. This growth and the frequent ear infections they cause can damage nearby structures. There are important structures close to the ear such as brain, facial nerve and inner ear. If the Choleteatoma grows upwards into the brain it can lead to meningitis or brain abscess. If it grows inwards and damages the inner ear it can cause complete irreversible hearing loss, tinnitus and vertigo. If it grows downwards it can damage the facial nerve resulted in a paralysed face on that side.
Image above on the left showing the entrance of a large sack of skin (Cholesteatoma) growing through the eardrum into the deeper part of the ear. This deeper part is where all the important structures live. The image on the right is what a normal eardrum should look like.
Above is a picture demonstrating how these sacks of skin look in the middle ear from side on. The cholesteatoma is the pink lumpy growth in the middle of the picture just to the right hand side of the eardrum, wrapped around the hearing bones. Note how only a thin plate of bone separates the cholesteatoma from the brain above and inner ear (blue structure) deeper in. A laser can be used to successfully destroy the skin stuck on the hearing bones.
Thankfully cholesteatoma can be effectively treated. The only treatemnt available is surgery and is best done early to protect the hearing bones from damage. Radiotherapy and medications don’t work. There are many surgical techniques to deal with Cholesteatomas and there is debate as to which way is best. Personally I offer laser assisted ear surgery which has the best chance of disease removal and hearing preservation (see procedures for more information).
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