Cholesteatoma is formed as a result of chronic inflammation of the middle ear. It appears as a cyst behind the tympanic membrane and invades the middle ear and mastoid cavity. This cyst contains skin cells and connective tissue. As these dead skin cells accumulate, the growth can increase in size and destroy the delicate bones of the middle ear. Consequently, surgery is often recommended to treat the condition. The operation of choice is tympanomastoidectomy, with removal or debridement of the cholesteatoma.

Cholesteatoma: Causes & symptoms

A cholesteatoma can be formed as a birth defect when skin cells become trapped in the middle ear before birth. However, in the majority of cases it is caused by repeated middle ear infections. This specific formation is caused in the majority of cases by the occurrence of repeated infections in the middle ear area.

In addition to repeated infections, a cholesteatoma can also be caused by disorders of the eustachian tube, which is the passageway that connects the back of the nose to the middle ear. If the eustachian tube is not working properly, a partial void may occur in the middle ear. This can cause part of the eardrum to pull into the middle ear, creating a cyst that can turn into a cholesteatoma. The growth then becomes larger as it fills with old skin cells, fluid and other waste.

Cholesteatoma: Unpleasant & dangerous symptoms

The symptoms caused by a cholesteatoma are initially mild, and gradually worsen as the cyst increases in size and begins to cause more serious problems. Initially, the affected ear may discharge a foul-smelling fluid. As the cyst grows, a feeling of pressure is gradually created in the ear, which can cause some discomfort combined with pain in or behind the ear. The pressure of the growing cyst can even cause hearing loss, tinnitus and balance disorders.

If the cholesteatoma causes compression or perfroration of the facial nerve, which passes through the middle ear, paralysis of the facial muscles may occur. At the same time, the sense of taste is disturbed if this particular growth causes perforation of the chorda tympani, which is a small nerve that passes through the eardrum. In cases of more severe symptoms, where the condition extends into the mastoid cavity, surgery with tympanomastoidectomy is the method of choice.

Tympanomastoidectomy: Surgical aim & process

Tympanomastoidectomy is performed in the majority of cases under general anesthesia. The degree to which the disease has spread also defines the scope of the operation. During the operation, a small incision is made in the back of the ear. Then, any growths inside the mastoid apophysis will be removed. It is important to check all the cavities of the mastoid apophysis in order to thoroughly remove the ​​cholesteatoma.

The goal is to remove all of the cholesteatoma while sparing as much of the normal structures of the ear as possible. After the cholesteatoma has been removed, it is important to ensure that the eardrum rupture is repaired. Tears in the eardrum can be repaired by placing a special graft over the hole in the eardrum, as in tympanoplasty. Excess scar tissue in the area is then removed.

With which procedures can this surgical technique be combined?

In case the condition has spread to the auditory ossicles, it is important to remove them. If a significant part of the bone is removed, a synthetic material can be used to replace it. This procedure is usually performed with a second surgery at a later time, in which the damaged bones of the middle ear are rebuilt. This operation is called ossiculoplasty, and is performed in conjunction with the complete removal of the cholesteatoma. It is important for the surgeon to pay attention so that no injury is done to the facial nerve which innervates the muscles of the facial area.

Tympanomastoidectomy: Post-operative course

At the end of the operation, the incision is closed with stitches, while a bandage is placed on the area. Patients stay in the hospital for one night after the operation, and refrain from daily activities for a period of 2 weeks. Then, their post-operative progress is regularly monitored by the attending physician. ENT Surgeon Athens Dr. Olga Papadopoulou performs the tympanomastoidectomy with optimal care in order to effectively remove or clean the cholesteatoma.