From the Guidelines
Surgical removal of the cholesteatoma through a procedure such as mastoidectomy is the recommended treatment, as it is necessary to prevent progressive damage to surrounding structures and potential complications. Cholesteatoma of the ear is a noncancerous growth of skin cells that develops in the middle ear behind the eardrum. The use of topical antibiotics, such as those reviewed by Morris 1, may be beneficial in resolving otorrhea, but their effectiveness compared to placebo in children is unclear.
Key Considerations
- The specific surgical approach depends on the extent of the cholesteatoma, with options including canal wall up or canal wall down procedures.
- Following surgery, patients typically need antibiotic ear drops to prevent infection, and regular follow-up appointments are essential due to the recurrence rate of 5-20%.
- Patients should avoid water exposure to the operated ear until cleared by their surgeon.
Post-Surgical Care
- Antibiotic ear drops, such as ciprofloxacin/dexamethasone, may be prescribed for 7-10 days to prevent infection.
- Follow-up appointments are usually scheduled at 1 week, 1 month, and then every 6-12 months to monitor for recurrence.
Importance of Treatment
- If left untreated, cholesteatomas can cause hearing loss, dizziness, facial nerve paralysis, or intracranial complications.
- Cholesteatomas develop when skin cells become trapped in the middle ear, often due to chronic ear infections or eustachian tube dysfunction, forming a sac that gradually expands and erodes surrounding structures.
From the Research
Definition and Characteristics of Cholesteatoma
- Cholesteatoma is a keratinizing epithelium within the middle-ear cleft or mastoid, characterized by otorrhea and hearing loss, and may lead to severe complications, intra- and extra-cranial 2, 3.
- It is the most severe middle ear disease, resulting from under-aeration of the middle ear cleft in most cases 2.
Diagnosis and Treatment of Cholesteatoma
- Cholesteatoma is diagnosed by micro-otoscopy, and when suspected, imaging is mandatory if otoscopy is inconclusive 2.
- There is no non-surgical treatment for cholesteatoma, and surgical treatment is the only option, with the goal of achieving a stable and safe ear 2.
- The choice of surgery depends on the extent of the disease, anatomic relationship between sensitive structures, and bony destruction caused by the disease 2.
Surgical Approaches for Cholesteatoma
- Surgical approaches for cholesteatoma include canal wall up mastoidectomy with tympanoplasty, canal wall down (radical) mastoidectomy with meatoplasty, and canal wall down (radical) mastoidectomy with reconstruction of external ear canal, tympanoplasty, and mastoid obliteration 2, 3, 4.
- A systematic review and meta-analysis found that canal-wall down with mastoid obliteration is associated with favorable outcomes compared to either canal-wall down without obliteration or canal-wall up 4.
- Another study found that canal-wall up cholesteatoma surgery with mastoid obliteration leads to lower rates of disease recurrence without affecting hearing outcomes 5.
Recurrence and Follow-up
- Cholesteatoma has a high recidivism rate, leading to repeated surgery, and a structured follow-up is needed after cholesteatoma surgery, with periodical otoscopy and MRI 2, 3.
- A study found that reconstruction of the posterior canal wall and/or obliteration of the mastoid may be the best surgical treatment alternative, with the lowest recidivism rate combined with a low post-operative ear discharge rate 3.