From the Guidelines
Cholesteatoma should be referred to an otolaryngologist for further evaluation and treatment to prevent serious complications, as it can cause conductive hearing loss due to pathology in the middle ear. This is supported by the most recent study from 2024, which emphasizes the importance of early intervention for conditions like cholesteatoma that can potentially be corrected with treatment 1.
Key Points
- Cholesteatoma is an abnormal skin growth in the middle ear that can destroy surrounding bone and cause serious complications if left untreated.
- Symptoms include persistent ear drainage with a foul odor, hearing loss, ear pressure, dizziness, and facial muscle weakness in advanced cases.
- Diagnosis requires examination by an otolaryngologist using an otoscope and possibly imaging studies like CT scans.
- Treatment almost always involves surgical removal of the cholesteatoma to prevent further damage to surrounding structures, with options including tympanoplasty, mastoidectomy, or a combination of both, depending on the extent of the growth 1.
Importance of Early Detection and Treatment
Early detection and treatment of cholesteatoma are crucial to prevent serious complications such as permanent hearing loss, meningitis, brain abscess, or facial nerve paralysis. Regular follow-up appointments are necessary to monitor for recurrence, which happens in about 20-30% of cases. The most recent guideline from 2024 highlights the need for referral to an otolaryngologist for definitive management of suspected cholesteatoma 1.
Management and Follow-Up
Management of cholesteatoma involves surgical removal, and follow-up care is essential to monitor for recurrence and prevent further complications. Topical antibiotic eardrops may be used in cases of acute tympanostomy tube otorrhea, but definitive management of cholesteatoma requires surgical intervention 1. Referral to an otolaryngologist is essential for the proper diagnosis and treatment of cholesteatoma, as emphasized by the recent study from 2024 1.
From the Research
Definition and Characteristics of Cholesteatoma
- Cholesteatoma is the most severe middle ear disease, characterized by otorrhea and hearing loss, and may lead to severe complications, intra- and extra-cranial 2.
- It is diagnosed by micro-otoscopy, and when suspected and otoscopy is inconclusive, imaging is mandatory 2.
Treatment Options for Cholesteatoma
- Surgical treatment is the only option for cholesteatoma, with the goal of achieving a stable and safe ear 2.
- The choice of surgery depends on the extent of the disease, the anatomic relationship between sensitive structures, and the bony destruction caused by the disease 2.
- Surgical approaches include canal wall up mastoidectomy with tympanoplasty, canal wall down (radical) mastoidectomy with meatoplasty, or canal wall down (radical) mastoidectomy with reconstruction of external ear canal, tympanoplasty, and mastoid obliteration 2, 3.
- Endoscopic ear surgery and mastoid obliteration techniques are also being used and show promise in reducing recidivistic disease rates 4, 5.
Management of Cholesteatoma in Specific Cases
- In cases where cholesteatoma is present in the only hearing ear, a less-rigid, functional approach favoring intact canal wall procedures may be adopted, rather than unequivocally committing to an open cavity 6.
- The EAONO/JOS classification and staging system provide a valuable framework for data collection and outcome assessment in cholesteatoma management 4.
- Selection of management technique will depend on disease characteristics, patient factors, and surgeon preference 5.