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Today on Summit ENT, we continue with yet another tantalizing ear condition that can cause hearing loss.

Repeated ear infections or retraction of the eardrum can allow skin into the middle ear, causing cholesteatomas. Cholesteatomas are abnormal skin growths in the middle ear, developing as cysts that shed old layers of skin. Over time, cholesteatomas can increase in size and destroy the bones of the middle ear (malleus, incus, and/or stapes) leading to hearing loss.

A cholesteatoma often occurs due to Eustachian tube dysfunction as well as chronic otitis media, or middle ear infections. Allergies, colds, or sinusitis can all cause the Eustachian tube to work poorly, resulting in a partial vacuum within the middle ear space. This pressure stretches the eardrum, causing an invagination, or a pouch or sac to develop in the area. Areas weakened by previous infections are particularly prone to cholesteatomas.

The primary sign for cholesteatoma is unilateral, chronic, foul-smelling ear discharge. As the cholesteatoma enlarges, it can cause a feeling of pressure in the ear, along with hearing loss. Dizziness or muscle weakness on one side of the face (usually on the side of the infected ear) can also occur. Any or all of these symptoms are good reasons to seek medical evaluation with your primary care doctor or ENT.

 Ask your doctor to examine your ear regularly.

Image Source: Mario Villafuerte

Otolaryngologists can use hearing or balance tests along with CT scans of the mastoid region to confirm the presence of a cholesteatoma. Initial treatment may consist of dry ear precautions, antibiotics, and ear drops, which aim to control infection by stopping the drainage in the ear. A large or complicated cholesteatoma usually requires surgical treatment to protect the patient from serious complications. The primary purpose of surgery is to remove the cholesteatoma to eliminate the infection and create a dry ear. A second surgery is sometimes necessary both to ensure that the cholesteatoma is gone as well as to attempt reconstruction of the damaged middle ear bones in an effort to improve hearing.

Cholesteatoma is a serious but treatable ear condition, which can be diagnosed only by medical examination. Bone erosion can cause the infection to spread into the surrounding areas, including the inner ear and brain. If untreated, deafness, brain abscess, meningitis, and death can occur. If you have any questions about your ears, seek out a medical professional to get it checked out.

Feature Image Source: Justin Chin

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