Ear cholesteatoma
Cholesteatoma of the ear is a tumor—like formation of the middle ear, which consists of keratinized epithelium and cholesterol crystals. It develops in the middle ear and spreads to the mastoid process and sinuses near the nose, in the process of growth it damages neighboring tissues. Cholesteatoma is divided into three types: congenital cholesteatoma, occurs when the ectodermal germ is formed incorrectly in the early stages and affects the temporal bone and the central nervous system. This type of cholesteatoma is very rare; secondary cholesteatoma occurs during inflammation of the middle ear and sinuses near the nose, due to mechanical transfer of the epithelium, keratin is produced and falls into areas where this structure is absent; false cholesteatoma is formed during inflammation or injury.
The content of the article:
Causes of cholesteatoma
Symptoms of cholesteatoma
Diagnosis of cholesteatoma
Complications of cholesteatoma
Treatment of cholesteatoma
Ear cholesteatoma
Causes of cholesteatoma
Chronic inflammation of the middle ear very often leads to purulent discharge, which ultimately changes the structure of the epithelium and forms a cholesteatoma. The presence of cholesteatoma provokes extensive damage to the middle ear. In cases of congenital cholesteatoma, which is also called true, the tumor has a smooth surface and therefore it was given the name pearl tumor. The reason for its occurrence lies in embryonic disorders. The cholesteatoma is located in the pyramid of the temporal bone.
False cholesteatoma occurs with chronic otitis media or due to injuries. False cholesteatoma occurs in two ways, it may be the ingrowth of the epithelium of the external auditory canal into the space of the middle ear through the rupture of the eardrum. The second way of penetration is associated with eustachiitis, with violation of the patency of the pipe. When the pressure in the tympanic cavity decreases, a part of the tympanic membrane is drawn into it, during which keratin and exfoliated epithelium accumulate, which leads to the formation of a cholesteatoma.
Symptoms of cholesteatoma
At the beginning of the disease, there are almost no symptoms, with further development, the patient complains of bursting sensations and aching pain in the ear. Vertigo attacks are often manifested. Hearing decreases and severe headaches occur. Purulent discharge from the ear appears, which has an unpleasant smell. A feature of the secretions will be the whitish color of the pieces that separate themselves. Hearing loss with cholesteatoma of the ear has a dual character. In one case, hearing loss is a violation of sound conduction due to limited mobility of the auditory bone. Another reason is associated with a disorder of sound perception due to toxic damage to the receptors of the labyrinth and the penetration of cholesteatoma secretions into it.
Diagnosis of cholesteatoma
An otolaryngologist can diagnose a cholesteatoma of the ear, a neurologist and a neurosurgeon also come to his aid. It is very common to detect signs of ear cholesteatoma by cranial runtgenography, but you can more accurately determine the disease by doing a CT scan of the skull. Diagnostic value along with clinical data is important. By doing a computed tomography of the temporal bones, you can get very valuable information about the disease. The picture of the X-ray analysis can be clarified only if the size of the cholesteatoma is determined, and its size, in turn, will help to determine changes in bone tissues.
Small-sized cholesteatomas may not be recognized on radiography, and large tumor-like cholesteatomas increase the size of the cave and the recesses above the eardrum. The cholesteatoma has a rounded appearance, the absence of such a rounded capsule indicates signs of an exacerbation of the disease. By applying otoscopy, it is possible to detect a marginal violation of the integrity of the walls of the tympanic membrane, signs of a violation of the bony part of the auditory canal, which is caused by the proliferation of tumor-like cholesteatoma. When an edge perforation is detected, the ear cavity is probed and the above-drum space is washed. The presence of a destructive process is indicated by the rough surface of the bone, but when determining cholesteatomas, epidermal scales are found in the washing waters. Also, patients with ear cholesteatoma are examined for hearing and vestibular apparatus using audiometry and vestibulometry. They also conduct research with a tuning fork to determine the patency of the auditory tube. In case of complications, neurological examination, electrocochleography, otoacoustic emission will help diagnose the disease. It is also very important to distinguish cholesteatoma from cochlear neuritis, sulfur plug, adhesive otitis and other tumors and foreign bodies.
Complications of cholesteatoma
During the destruction of bone tissues, the cholesteatoma increases in size. In the process of growth, the tumor fills the cells of the mastoid process, it moves up to the capsule of the labyrinth and destroys the semicircular tubules, provokes the appearance of a labyrinth fistula. When the cortical layer of the mastoid process is destroyed, the tumor passes under the skin of the mastoid region.
Cholesteatoma often leads to paresis of the facial nerve due to the destruction of the walls of the bone canal. When a cholesteatoma penetrates into the inner ear, dizziness and weakness of the facial muscles very often occur. In rare, individual cases, cholesteatoma leads to brain infection and other severe infections. When using a special ENT microscope, the doctor can see the tumor, which is not always possible to detect during otoscopy. An audiogram will help determine the level of hearing loss, and a CT scan will tell you about the size of the tumor and the degree of tissue damage. Very often, the tumor reaches the size of a walnut and has processes that are directed in different directions. A long—standing cholesteatoma of the ear has toxic components that cause the development of aseptic meningitis when it breaks through, and the development of meningoencephalitis when it enters the brain fluid. Such complications cause swelling of the brain, which ultimately leads to death.
Treatment of cholesteatoma
In the case of a small cholesteatoma of the ear, which is located in the supra-drum space, conservative treatment is possible. In this case, washing with solutions of proteolytic enzymes and boric acid is carried out. The washing begins with an isotonic solution and ends with it. Such washings are prescribed every day for a week. If the cholesteatoma has reached an impressive size and conservative treatment does not help, then surgical intervention is used and the tumor is removed. Depending on the area affected by cholesteatoma, surgery includes sanitizing surgery, labyrinthotomy, myringoplasty and other manipulations. Such a method as tympanoplasty is very common, surgery is performed in the middle ear, mastoidectomy is added to such surgery, in which pus is removed from the cavity of the mastoid process. There is also a method of ossiculoplasty, which is aimed at restoring the transmission of sound from the eardrum to the inner ear. There are two types of surgical intervention, one of them is performed through the ear canal and is called transcanal, the other method is called the behind—the-ear approach, which is performed by incision behind the ear, which opens access to the mastoid process and the space of the middle ear. You also need to understand that the resumption of hearing is in this case in the background and may not even be achieved. In individual cases, the patient may need two operations, the first is tympanoplasty, the purpose of which is to remove the cholesteatoma, and if possible, restore hearing. Operation number two is scheduled seven or nine months after the first one.
Surgical removal is performed on an outpatient basis and the next visit to the doctor is scheduled in a few weeks. There are many methods and a huge number of prostheses that are used for reconstruction. An important factor for the prevention of ear cholesteatoma in the formation of otitis will be timely and high-quality treatment.
