Cholesteatoma, Chronic Otitis Media
Chronic otitis media is a common cause of recurrent ear infections characterized by ear drainage (otorrhea) and hearing loss. The otorrhea may be temporarily suppressed with antibiotic therapy. Nevertheless due to irreversible changes in the middle ear and mastoid mucosal lining, the diseased ear continues to be susceptible to infection. Surgery is usually required to remove this diseased tissue to prevent recurrent infection. Untreated chronic otitis media can lead to vertigo, tinnitus (ear noises), sensorineural hearing loss in addition to conductive hearing deficits due to erosion of the middle ear structures: tympanic membrane (ear drum), malleus, incus, and stapes (the little bones of hearing). More extensive disease can be associated with facial paralysis, meningitis and brain abscess.
Cholesteatoma is an abnormal accumulation of skin found in the middle ear and/or the mastoid. The periphery of cholesteatoma incites an inflammatory reaction of the adjacent bone of the mastoid and middle ear cleft. This inflammatory enzymatic reaction can lead to soft tissue bone destruction. If untreated, cholesteatoma will eventually erode the middle ear structures (little bones of hearing), the labyrinth (the inner ear) to cause loss of hearing, dizziness or vertigo and facial paralysis. Chronic infections associated with cholesteatoma can ultimately cause life threatening meningitis and brain abscess.
Treatment of cholesteatoma and chronic otitis media is with surgical removal of disease (tympanomastoidectomy) with the intent to create a safe dry ear in which cholesteatoma and chronic otitis media do not recur. After these first two goals are met, the hearing may be restored with middle ear and ossicular (little bones of hearing) reconstruction. The extent of the middle ear and mastoid destruction by chronic otitis media and/or cholesteatoma will adversely affect the degree of hearing restoration: the more severe the underlying disease, the less likely normal hearing will be achieved or maintained over the long term. Good eustachian tube function, which provides middle ear aeration, is another factor that contributes to successful long term hearing restoration.
Dr. Hammerschlag can discuss the various surgical options and reconstruction strategies that is best for your particular situation. For example, the hearing reconstruction may be delayed to maximize middle ear anatomical stability after several months to ensure a more precise reconstruction. A second "stage" surgery also will facilitate reinspection of the operative site for persistent cholesteatoma if there is concern about incomplete disease removal at the first stage. (Sometimes initial complete disease removal may damage important structures in the middle ear). Removal of residual disease may be less risky after the clearance of adjacent inflammation following the first stage.
As noted earlier, the longterm prevention of cholesteatoma and chronic otitis media and the maintenance of hearing stability may depend of effective eustachian tube function as well as the extent of disease destruction at the time of surgery. The eustachian tube normally provides aeration of the middle ear cleft. When the eustachian tube functions poorly, negatively aerated middle ear space occurs. The negative pressure affect, not unlike a vacuum, may cause inward displacement of the skin lined tympanic membrane (ear drum) which can lead to reformation of chronic otitis media and cholesteatoma.
Patients who have had surgery for cholesteatoma/chronic otitis media should be followed at least on an annual basis (for the rest of their lives) by an otologist to monitor for possible of recurrence of disease and ensure stability of auditory function. If there is an open mastoid cavity, it needs to be cleaned of accumulated dead skin every several months because the wax secreting glands found in the normal ear canal skin may not be present in the skin lining the mastoid cavity.