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What is a cholesteatoma?

In this condition skin accumulates in the middle ear.

How does it get there?

There are several reasons cited for this situation to arise. The most popular explanation is negative pressure within the middle ear, which has a suction effect on a part of the ear drum. As this area gets sucked inwards it forms a ‘pocket’ called a retraction . Dead skin cells accumulate in this pocket, and with time it grows deeper.


What problems does it cause?

As it enlarges and comes in contact with various important structures in and around the middle ear. Gradually it eats away at these structures. Important structures include the ossicles (small bones that transmit sound waves) causing a hearing loss. The accumulated skin is rich material for bacterial growth, and infection can lead to a foul smelling discharge.

Although, the growth of a Cholesteatoma is slow, over a period of time it can erode through important bony barriers around the middle ear. Its natural progression is towards the mastoid part of the temporal bone (this houses your middle ear). Important adjacent structures include the nerve that moves the face muscles (facial nerve), balance system, brain coverings (meninges), and the brain itself. All these can be affected leading to complications.

What is its treatment?

Treatment for this condition is surgical. The principle of surgery is to take the Cholesteatoma out in its entirety, prevent its progression, and avoid complications. The procedure is called a mastoid exploration. It is done under a general anaesthetic. The procedure can (depending on the case) take up to 3 hours. It is sometimes important to go back (after a year or so) and explore the ear to rule out a recurrence of this problem.

Cholesteatoma surgery is done using a microscope.
Picture of a normal ear drum
Picture of a sucked in or retracted ear drum that can go on to develop a cholesteatoma
A cholesteatoma with white skin debris and infection. The discharge is foul smelling.
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