Chronic middle ear infections (cholesteatoma)

What is it?

A cholesteatoma is a type of chronic middle ear infection where skin cells grow inwards towards the middle ear and can cause damage.

Origin

An eardrum is tight, like a trampoline. For some people, a portion of the eardrum loses its surface tension and a dip forms (a retraction pocket). The pocket is not usually very deep and has gradual, sloping walls. Skin flakes are then able to collect in this pocket (naturally occurring skin flakes mix with sebum, thus forming the earwax that is then directed towards the entrance of the ear canal).

If the pocket becomes too deep, or if the walls are too steep and/or the angle is too sharp, the skin flakes remain at the bottom of the pocket.

Just like a sail cloth in the garden that has standing water collecting in it, it gradually rots.

This process can also occur with the skin enzymes. They further thin out the eardrum, making the pocket deeper and deeper. In the end, a eardrum becomes a sort of trunk that leads to the middle ear, and grows around the auditory bones.

The entire middle ear and the cavities behind (the mastoid) it can fill up. Such a cholesteatoma is never malignant. But because it applies constant pressure, it can damage the delicate structures, primarily the auditory bones, in the ear.

Symptoms

Many patients go for years without symptoms and do not even realise they have this condition. Suddenly, however, the cholesteatoma begins to apply pressure and to cause problems like severe ear infections. The cholesteatoma can also grow around structures towards the facial nerve (facial paralysis), towards the inner ear (deafness, balance disorders) or towards the brain (meningitis). This sounds horrible, but it is very, very rare!

Diagnosis

A diagnosis is confirmed using otoscopy (visual examination inside the ear), a hearing test, a CT scan, and, if needed, a NMR (specific views).

Treatment

Read more here about the treatment of cholesteatomas.

Latest publication date: 13/12/2023
Supervising author: Dr Vermeiren Judith