Cholesteatoma is a cyst of skin in the ear or skull base. The majority of these are caused by chronic ear infections, eardrum perforations or Eustachian tube problems. Occasionally they are congenital, having formed from pieces of skin deposited in the ear during the embryological development of the ear. The cyst consists of layers of skin (epithelium), and are benign tumors that may be locally destructive.

Many cholesteatomas are asymptomatic. They can become infected and cause drainage of liquid or pus out of the ear. They often cause hearing loss as they interfere with the vibration of the eardrum or bones of hearing in the middle ear. The patient may have a recurrent ear discharge. If left untreated, a cholesteatoma may erode the three small bones located in the middle ear and cause more significant hearing loss and/or extend into the mastoid bone. With extensive growth, cholesteatoma can erode into the inner ear and cause nerve deafness or even extend into the brain and cause meningitis or brain abscess. Dizziness, vertigo and facial paralysis are rare symptoms of cholesteatoma.

The treatment of cholesteatoma is usually surgical. Small cholesteatomas can sometimes be watched, but most need surgery to remove them. The operation is usually performed as a tympanomastoidectomy. Occasionally more extensive procedures are required for their removal. Because of their high recurrence rate, a second stage procedure is usually performed 6-12 months later to insure the entire cyst was removed during the first surgery, the so-called second look procedure.

Cholesteatoma - Ear Associates, San Jose Ca
Cholesteatoma that has eroded the bones of hearing in the middle ear

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