Medicines for Cholesteatoma

What it is

A cholesteatoma is an abnormal collection of skin cells that develops in the middle ear (behind the eardrum) or the mastoid bone behind the ear. Despite the name, it is not a tumour or cancer — it is a growth of ordinary skin cells in a place they should not be. It often develops in relation to long-standing problems with ear ventilation and drainage (for example from repeated ear infections or long-term Eustachian tube dysfunction), which can draw part of the eardrum inwards to form a pocket where skin cells collect. Over time, a cholesteatoma gradually grows and, as it enlarges, it can erode and damage the surrounding structures — including the tiny hearing bones (causing hearing loss), and, if it continues, potentially the balance organs, the facial nerve, and the bone separating the ear from the brain, which is why it can lead to serious complications if untreated. Typical symptoms include a persistent or recurrent smelly discharge from the ear, gradual hearing loss in the affected ear, and sometimes a feeling of fullness, earache, dizziness, or ringing. Because a cholesteatoma tends to grow and can cause progressive damage, it is important to diagnose and treat it, and it usually needs surgery. It is diagnosed by examining the ear (often with a specialist) and scans.

How it is treated

A cholesteatoma is managed by an ENT specialist, and, because it does not resolve on its own and tends to grow and cause damage, the main treatment is surgery to remove it. The specialist assesses the ear (including examination and usually a CT scan to see the extent) and plans an operation — typically a "mastoidectomy" (removing the cholesteatoma from the middle ear and mastoid bone) and, where possible, repairing or reconstructing the affected structures, including the eardrum and, sometimes, the hearing bones. The main aims of surgery are to remove the cholesteatoma completely to create a safe, dry ear and prevent the serious complications it can cause, and, where possible, to preserve or improve hearing (though the priority is a safe ear). Because cholesteatomas can recur, follow-up is important, and sometimes a second operation is planned to check for any regrowth. Before or after surgery, any infection and discharge are treated (for example with ear drops and keeping the ear dry). Untreated, a cholesteatoma can cause progressive hearing loss and, occasionally, serious complications (such as infection spreading to the balance organ, facial nerve, or towards the brain), which is why treatment is important. The reassuring message is that a cholesteatoma, though it needs treatment because it grows and can damage the ear, is not a cancer and is treated effectively with surgery to remove it and make the ear safe, with follow-up to check for recurrence.