From the Research
The primary treatment for cholesteatoma is surgical removal, with the goal of completely removing the cholesteatoma, repairing any damage to surrounding structures, and restoring hearing when possible, as supported by the most recent and highest quality study 1. The specific surgical approach depends on the extent of the disease, with options including:
- Tympanoplasty
- Mastoidectomy
- A combined procedure called tympanomastoidectomy Surgery aims to produce an ear that is easy to care for and is free of recurrent or residual cholesteatoma, with hearing improvement being of secondary importance 2. Before surgery, patients may receive antibiotics to treat any active infection, typically amoxicillin-clavulanate (875/125 mg twice daily for 7-10 days) or ciprofloxacin otic drops (4 drops twice daily for 7 days) for ear drainage, as seen in a study from 3. Regular cleaning of the ear by an otolaryngologist is also important to manage drainage and prevent complications. Following surgery, patients require long-term follow-up with an otolaryngologist, typically every 6-12 months, as cholesteatoma has a recurrence rate of 5-20% 1. Surgical intervention is necessary because cholesteatomas continue to grow if left untreated, potentially causing serious complications including:
- Hearing loss
- Facial nerve paralysis
- Meningitis
- Brain abscess by eroding surrounding bone and tissue. The choice of surgical technique, such as open cavity, combined approach, or reconstruction of the mastoid cavity, depends on the individual case and the surgeon's experience, with reconstruction of the posterior canal wall and/or obliteration of the mastoid appearing to provide the lowest recidivism rate combined with a low post-operative ear discharge rate 1.