Ear cholesteatoma what are the causes and treatment

Tympanoplasty is a surgery on the middle ear to restore the eardrum to improve hearing.

Tympanoplasty is the best alternative to a hearing aid. According to statistics, after such an operation, 60-70% of patients showed an improvement in hearing.

Hearing improvement due to tympanoplasty restoration of the eardrum is most successful if during audiometry you feel sound starting at a level of 20 decibels. To do this, an examination is performed – audiometry. However, research and practical experience can improve hearing when any damage to the eardrum does not exceed 5 mm.

In the process of tympanoplasty, ENT, the surgeon reorganizes the auditory canal, restores the anatomical location of the sound-conducting canal, auditory ossicles, and eliminates damage to the tympanic membrane.

If it is impossible to restore the natural elements of the hearing organs, grafts are used.

The most common cholesteatoma is formed in the middle ear.

A cholesteatoma is a capsule with a layered structure. In the center of the tumor, like a nucleus, is detritus. It contains infectious agents and has the smell of rot. The core surrounds a layer of cholesterol and epithelium. All this is covered by the outer shell – the matrix, which is a capsule of stratified keratinized epithelium. By its appearance, the cholesteatoma can be single or multinodular.

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Types of Cholesteatoma

Three types of cholesteatoma are distinguished depending on the place of tumor formation:

  • Middle ear;
  • Temporal bone cholesteatoma. Often fixed jaw lesion;
  • Brain. Here the cerebellar angle is damaged.

Additionally, the disease is classified by signs:

  • Congenital disease. Doctors often refer to this species as a true disease. Violations are recorded during fetal development. The child has a predisposition to ear diseases. Congenital cholesteatoma has a smooth surface. The appearance of the tumor resembles a pearl located in the area of ​​the pyramid of the temporal bone. There are other places where you can find the true disease: the lateral parts of the cranium, the ventricles of the GM, the side tanks.
  • Acquired in the process of life. Another name is a false disease. At risk are adults. Frequent otitis media, which takes a long time, physical impact on the external part of the hearing organ, and barotrauma, which is typical for people engaged in diving and underwater research, can provoke the appearance of this type.

Possible complications

Without adequate treatment, the process is accompanied by intracranial complications:

The neoplasm can grow and thus squeeze the tissues that surround it. This affects the temporal bone, since the cholesteatoma after penetration under the scalp affects the facial nerve. “Pearl” squeezes the channels of the hearing aid, and this leads to hearing loss.

Although a cholesteatoma is called a tumor, it is not. Do not be afraid that it will develop into cancer, as it is a completely different process. But a person should not forget about treatment. It all starts with the discomfort that accompanies the growth of the tumor. Gradually, the cholesteatoma rewards the patient with a whole bunch of diseases.

You should not be afraid of the transition of the disease to cancer, since the cholesteatoma itself is not a tumor. It is not divided into parts, does not penetrate the bloodstream and does not metastasize to other organs. However, this does not mean that you can give up on an ailment. In addition to the unpleasant sensations of a cholesteatoma, it is able to give its owner a whole bunch of complications.

Growing, the ear “pearl” squeezes the surrounding tissue. First of all, the mastoid process, which is part of the temporal bone, suffers from such aggression. Destroying it, the cholesteatoma penetrates under the scalp and affects the facial nerve.

With large sizes, the formation reaches the cavity of the inner ear and squeezes the tubules of the auditory apparatus, which leads to the development of hearing loss.

In the worst case, the process is aggravated by intracranial complications:

  • meningitis
  • abscess
  • cerebral thrombosis.

Gradually increasing in size, the ear cholesteatoma destroys nearby bone tissue. Further development can provoke the destruction of the walls of the bone channel of the facial nerve. Ultimately, there is a risk of developing paresis of the facial nerve. If the destruction is directed to the walls of the sigmoid sinus, sinus thrombosis develops.

A long-standing capsule of cholesteatoma contains a toxic fluid. If fluid breaks into the subarachnoid space, the development of aseptic meningitis may occur. In the case of penetration of toxic fluid into the substance of the brain, a person develops meningoencephalitis.

Complications of this kind can lead to very serious consequences, up to the death of the patient.

Symptoms of cholesteatoma can occur in the form of hearing loss, sensation of a foreign object in the ear, itching inside the auricle, pain. When you try to clean the ear canal, a secret is released with an unpleasant putrefactive odor and gray. As the size of the tumor increases, an acute pain syndrome of a pressing or shooting nature develops.

Signs may include headaches, general weakness, irritability. If complications in the form of labyrinthitis develop, then the patient has severe dizziness, at the height of which reflex cerebral vomiting may occur. Timely diagnosis is possible when contacting an otolaryngologist.

Already during the initial examination of auditory viewing, the doctor can detect a “pearl tumor” surrounded by characteristic connective tissue. In the process of washing the tympanic cavity in the liquid, small white lumps of the internal contents of the cholesteatoma are determined.

For the purpose of diagnosis, in addition to otoscopy, a radiography is performed to exclude the presence of neoplasms in the pyramidal structure of the temporal bone. After a full examination, a decision is made on the tactics of the treatment.

Complications can develop with a long course of pathology without attempted treatment. They include acute and chronic labyrinthitis, toxic neuritis, hearing loss. It should be understood that this tumor tends to grow quite fast. It can reach the size of a ripe walnut, while surrounding bone and epithelial tissues are drawn into the pathological transformation process. External germination and damage to the facial nerve is possible, which leads to paralysis of the facial muscles.

With the innate truth of cholesteatoma, a child may develop meningitis and encephalitis. The toxic contents of the internal cavity can provoke a delay in mental development. Sepsis and brain abscess often lead to the death of babies. In this regard, it is necessary to conduct a timely operation to remove a dangerous neoplasm.

When the cholesteatoma increases greatly, the destruction of the semicircular tubules of the bone labyrinth, the sigmoid sinus and the channel in which the facial nerve is located is possible. Along with this, an overgrown clot can fill the cells of the mastoid process and cause destruction of the cortical layer.

All these changes lead to dangerous consequences:

  • facial nerve neuritis;
  • purulent or serous labyrinthitis;
  • blockage of the sigmo >

In addition, a neglected pathology can burst. The toxic fluid inside is spilled. And if this happens in the subarachnoid space, then the membranes of the brain become inflamed, which provokes the development of aseptic meningitis. When pathogenic contents enter the brain, meningoencephalitis develops. These complications are very dangerous and a fatal outcome is possible with their development.

The constant ingress of pathogenic microflora into the patient’s blood and infection leads to the development of otogenic sepsis.

In addition, the development of subdural, epidural and extradural abscesses is possible – the formation of pus in the cranium.

Important! Complications are life-threatening! The disease cannot be started. It is urgent to identify the causes that led to the malaise and begin their therapy.

During the destruction of bone tissue, the cholesteatoma increases in size. In the process of growth, the tumor fills the cells of the mastoid process, it advances to the capsule of the labyrinth and destroys the semicircular tubules, causing the appearance of the labyrinth fistula. When the destruction of the cortical layer of the mastoid process occurs, the tumor passes under the skin of the mastoid region.

Cholesteatoma often leads to paresis of the facial nerve due to the destruction of the walls of the bone channel. When cholesteatoma penetrates the inner ear, dizziness and weakness of the muscles of the face very often occur. In rare, individual, cases of cholesteatoma, brain infections and other serious infections are caused.

When using a special ENT microscope, the doctor can see the tumor, which is not always possible to find when conducting otoscopy. An audiogram will help determine the level of hearing loss, and computed tomography will tell about the size of the tumor and the degree of tissue damage. Very often, the tumor reaches the size of a walnut and has processes that are directed in different directions.

If the treatment is untimely, the disease has already been started, or the mother was self-medicating and only hurt the baby, a transition to a chronic form or the development of other pathological processes is possible:

  1. Mastoiditis.
  2. Cholesteatoma.
  3. Hearing loss.
  4. Disruption of the vestibular apparatus.
  5. Paresis of the facial nerve.
  6. Meningeal syndrome.

How is otitis media treated?

Treatment is symptomatic. Prescribe antiemetic drugs, antihistamines. Locally applied patches, including scopolamine. Steroids are used to reduce inflammation, and sedatives are used against the patient’s anxiety. If the etiology of internal otitis media is bacterial, antibiotics are prescribed.

In the case of ineffective medication for otitis media, surgery is performed, for example, opening the semicircular canal of the labyrinth, opening the temporal bone pyramid or other operations.

How to treat otitis media in a child

As a rule, otitis media occurs abruptly and before going to the doctor (and this must be done), it is necessary to give your child first aid, at least in order to relieve or reduce pain, and also bring down the temperature if it rises.

For the first steps you will need:

  1. Give the child pain medication. For young children, ibuprofen or paracetamol-based medicines are well suited.
  2. In order to relieve swelling from the mucous membrane of the auditory tube or nasopharynx, which will also reduce pain, it is necessary to instill the nose with vasoconstrictor drugs. Vibrocil, Nazol, Otrivin may come up.
  3. If the inflammatory process is accompanied by fever, it is necessary to give the child an antipyretic in accordance with age norms.

But you should not bury the ears yourself. First, the doctor must examine them and only then treatment will be prescribed.

Depending on the reasons that caused the development of otitis media, and the degree of the disease, the doctor may prescribe such drugs:

  1. Antibiotics in case of an infectious process.
  2. Antibacterial drops for the ears.
  3. Antiviral drugs.
  4. Vasoconstrictor drugs.
  5. Antihistamines to relieve swelling.
  6. Non-steroidal drops with anti-inflammatory and analgesic effects.
  7. Glucocorticoids in the form of ear drops to relieve swelling and itching, as well as inflammation.
  8. Antiseptic drugs.
  9. Physiotherapeutic procedures.
  10. Antipyretic drugs, if the temperature continues to rise after the start of appropriate treatment.

Treatment of otitis media in children at home is possible, but only in accordance with the prescription of a doctor. Also, the doctor may suggest the use of alternative medicine.

  1. Until the formation of the boil, lotions are allowed to be made with an alcoholic solution of boric acid.
  2. When a boil appears, it is necessary to treat it with iodine.
  3. To remove inflammation from the outer part of the ear, cut aloe leaves are used.
  4. Warming compresses. You can also use bags with warm contents or the glow of a blue lamp. Unacceptable with a purulent process.

Otomycosis treatment

Congenital and acquired cholesteatomas can be removed using one of two methods. Specialists use conservative treatment and surgery.

Each patient is shown a specific therapy. Conservative treatment takes from 7 days to 2 weeks.

Applicable if the formation is small and has not yet had time to grow through the eardrum. The doctor prescribes the patient a washing of the supmembrane space.

Ear washing is done daily for 7 days. This time should be enough for the cholesteatoma to disappear. In medical practice, cases have been recorded when it grows again. Therefore, if the patient got rid of her, it is worth some time to undergo observation by a doctor.

Conservative treatment in rare cases will help solve the problem of a large neoplasm in the ear. Rinsing with solutions even with a small pearl neoplasm does not always give a positive result. Surgical intervention allows you to remove the tumor in a short time and return the patient to a full life. The type of surgery depends on the ear region, which was affected by a cholesteatoma.

Surgical treatment is carried out in the following order:

  1. Removal of a pearl neoplasm.
  2. Treatment of the ear cavity with solutions in order to exclude the re-development of the infectious process.
  3. Restoring the integrity of the eardrum.
  4. Renewal of damaged auditory ossicles.

Regardless of the type of surgery, it is performed under general anesthesia. For accurate diagnosis and successful treatment of the patient using modern equipment and tools.

This avoids excessive traumatic hearing. Moreover, this approach reduces the time to restore the patient’s health.

During a sanitizing operation, the middle ear is cleansed of altered tissues

Two methods are used for treatment: conservative or operative.

Conservative

At the very beginning of the development of cholesteatoma with minor tissue damage, conservative methods of therapy are used.

For this, the drum space is washed to remove the curd. Solutions of boric acid and proteolytic enzymes are used. The cavity is washed with an isotonic solution at the beginning and end of the procedure. A positive effect can be seen after seven days of washing. Washed cholesteatoma can develop again, so you need to regularly visit your doctor.

In addition to washing, drug therapy is used for analgesic and anti-inflammatory effects, medications to reduce blood pressure and improve blood circulation.

A set of therapeutic agents is prescribed by the doctor according to the results of analyzes and studies.

Operating room

The following types of surgical intervention are possible:

  • myringoplasty;
  • mastoidoplasty;
  • tympanoplasty;
  • mastoidotomy;
  • trans labyrinth opening of the pyramid of the temporal bone;
  • labyrinthectomy;
  • sanitizing surgery.

During the sanitizing operation, the middle ear is cleansed of altered tissues. The work of the eardrum and its cavity is restored.

Mastoidotomy is used to destroy the abscess in the mastoid process and drainage of the tympanum.

Labyrinectomy makes it possible to create conditions for the free outflow of pus.

A trans-labyrinth opening of the pyramid of the temporal bone eliminates the purulent focus, reduces the risk of inflammation of the meninges and neighboring parts of the brain.

Tympanoplasty and myringoplasty can close the ruptures of the eardrum. This helps improve the patient’s hearing and reduces the risk of infection.

Mastoidoplasty is performed to reconstruct the mastoid process of the temporal bone.

Cholesteatoma can be removed in two ways: behind the ear or transcanal. Surgery is carried out only under general anesthesia in a hospital setting.

During the postoperative period, physiotherapeutic procedures are applied in the form of short-wave ultraviolet radiation, UHF, and a laser.

In the early stages, conservative treatment is practiced. Curd masses are washed from the ear canal with a solution of proteolytic enzymes. The procedure is carried out daily for a week. Since the cholesteatoma can grow again, even after complete cure the patient is subject to regular monitoring by a specialist.

With ineffective washings or large tumors, surgical intervention is indicated. Sometimes surgery is preceded by drug therapy. For example, if a patient has exacerbated chronic otitis media or has been diagnosed with inflammation of the eardrum (mucositis), he is prescribed a course of antibiotics.

The operation is performed under general anesthesia. The course of the procedure depends on the prevalence of cholesteatoma. To begin with, the surgeon removes all altered anatomical formations – the tumor itself, the affected areas of the bones and mucous membranes. If necessary, open the mastoid process and the labyrinth of the inner ear. Affected auditory ossicles are restored using cartilage taken from the patient’s ribs.

At the final stage of the operation, tympanoplasty is performed (close the hole in the tympanic membrane). As a “patch” set their own tissue of the patient. The flap is glued to the membrane using special hyaluronic films. Over time, when the implant has completely taken root, the films will resolve. The whole procedure is under the control of a microscope.

Within a year after the operation, the patient is recommended to protect the ear from possible infections and hypothermia.

A cholesteatoma is only treated surgically. A progressive cholesteatoma may require a complex operation or a series of operations to correct the auditory ossicles. Since the cyst may form again, repeated operations may be necessary.

The operation may include reconstruction of the auditory ossicles to restore hearing loss. For reconstruction, parts of natural bone or artificial devices (prostheses) may be needed.

In severe cases, the doctor may resort to radical methods, such as mastidectomy. This will require periodic cleaning of the cavity. To restore the lost hearing, unfortunately, in this case will not work.

If otitis media is purulent, then antibiotic therapy is prescribed for at least 5-7 days. With catarrhal otitis media, wait-and-see tactics are most often used, the patient’s condition is monitored for 48 hours, only antipyretic drugs and ear drops are used.

Therapy for people with Meniere’s disease consists of two parts:

  1. 1. Long. It is based on proper nutrition, compliance with the regimen, psychological support of the patient, the appointment of drugs to improve microcirculation in the inner ear, reduce the permeability of capillaries, atropine, diuretics and some other drugs.
  2. 2. Cupping an attack. It is represented by the appointment of antipsychotics, scopolamine and atropine drugs, vasodilators, antihistamines and diuretics.

In the event that drug therapy does not produce results, surgical intervention in the form of a draining, destructive operation or surgery on the autonomic nervous system is indicated.

Therapy for otomycosis is based on the use of antifungal drugs. Local washing of the middle ear, external auditory meatus or cavity after surgery using antifungal agents after the ear has been cleaned of desquamated epidermis, earwax and mycelium of the fungus.

Prescribe vitamins, fortifying drugs and antihistamines.

The inflammatory process that affects the mastoid process of the temporal bone, which develops as a result of infection, is called mastoiditis and is a complication of acute otitis media.

Due to the development, several types of mastoiditis are distinguished:

  • Primary or secondary.
  • Otogenic, hematogenous and traumatic.

According to clinical manifestations, a typical and atypical form is distinguished.

Symptoms of mastoiditis appear 1-2 weeks after the onset of otitis media. Clinical manifestations start with a deterioration in the general condition of the patient, a rise in temperature to febrile indicators, intoxication, headaches, and sleep disturbances. The patient complains of noise in the ear, pain in it, intense pain behind the ear, sensation of pulsation in the region of the mastoid process. It radiates to the temporal and parietal regions, the orbit and upper jaw. All this is accompanied by severe suppuration from the ear.

The treatment of mastoiditis is based on the use of broad-spectrum antibiotics, antihistamines and anti-inflammatory drugs, and detoxification. If the cause of mastoiditis is otogenic, a sanitizing operation is prescribed.

We learn how to treat diseases of the inner ear.

The first thing to note is that not all, unfortunately, diseases in this case can be cured. If, for example, the auditory receptors or corti die off, the organ heals, there is no way to restore the hearing at all. In severe cases, hearing aid sometimes saves.

Currently, medicine does not have conservative means to combat this type of neoplasm. Treatment of cholesteatoma is possible only surgically. Only an operation to remove cholesteatoma is possible, which, however, does not guarantee the absence of relapse in the short term.

In the presence of contraindications and with a small tumor, regular weekly washing of the tympanum is performed. This is done in order to eliminate the toxic secretion, which is able to destroy the nerve fiber and have a negative impact on the functioning of the brain. Immediately after eliminating possible contraindications to surgery, it is carried out in a planned manner.

After the operation, avoid overcooling the body, protect the ear cavity from the penetration of cold air. Requires long-term follow-up at the otolaryngologist.

Otolaryngologist Vlasova Marina

A small formation can be eliminated by the use of certain drugs.

Causes of Ear Cholesteatoma

Due to its resemblance to a pearl, another name for the disease is pearl swelling. This curd lump will consist of layers forming the upper edge of the external auditory canal, freely passes through the eardrum and enters the cavity of the middle ear. The tumor will get here in the amount of 2-3 millimeters, gradually growing to 7 centimeters.

The inner part of the auditory organ is damaged – there is a suspicion of a cholesteatoma, it is felt in the early period of the disease. Accumulation of dead epithelium – these conditions most contribute to the development of cholesteatoma, more precisely, bacteria that provoke the inflammatory process. External signs of damage appear in the form of purulent discharge with an unpleasant odor. In the ear canal, the passages become clogged, which leads to extraneous sounds in the ears, and the hearing quality decreases.

During the disease, an improvement or worsening occurs, during this period the patient feels severe pain.

Causes

Lesions of a congenital or acquired nature begin even in the embryonic state. In the case of a false type cholesteatoma, the disease is inside and is activated by the following actions:

  • The auricle was exposed and damaged.
  • Otitis with prolonged treatment.
  • Violation of the integrity of the eardrum.
  • The auditory canal is narrowed or full.
  • Inflammation inside the auditory tube.

Doctors say that a false disease has two mechanisms of occurrence:

  • Eustachitis causes damage to the auditory canal.
  • The epithelium forming the auditory tubes grows into the middle ear cavity.

Symptoms

When the formation of a tumor occurs, the process goes quietly, preventing pathognomonic signs and unpleasant sensations from developing. Gradually, when the formed formation is fixed inside, the characteristic symptoms of cholesteatoma begin to appear. Signs of the disease:

  • The patient complains that the ear is bursting from the inside.
  • Pain syndrome appears, ranging from a dull and aching sensation to a shooting one.
  • The quality of audibility is reduced. Two factors can play a role here. Firstly, hearing impairment occurs due to the immobility of the auditory ossicles or their weak motor activity. The second factor is the negative effect of the discharge on the elements responsible for the adoption of sound.
  • Concerned about intense headaches. The development of the syndrome is due to the fact that the discharge cannot go outside. Also, the cause of pain in the head is an increase in the volume of formation when water penetrates inside.
  • If the patient has labyrinthitis, an additional symptom is present – dizziness.
  • A curd mass with an unpleasant odor reminiscent of rot is constantly standing out from the ear.
  • Sometimes the discharge looks like small lumps of white.

The appearance of intracranial pain should be noted, since this often suggests that the brain is damaged inside.

Complications

During the diagnosis, a large cavity inside the middle ear formed by the disease is clearly visible in the photo. The processes of the tumor diverge in different directions. If development is not stopped, the processes are able to reach the fallopian canal. If the walls of the element are damaged, paresis of the facial nerve occurs. When the cholesteatoma moves down to the lower region of the temporal lobe, the formation of the outward appearance is not excluded.

Gradually, the formation of growths with the liquid contents of a toxic composition occurs. If one of the capsules bursts and the contents reach the surface of the brain, the patient may develop toxic meningitis.

As a result of the lack of therapeutic measures, a benign tumor-like disease is reborn and is capable of causing significant damage to the patient’s health or even to life. Effects:

  • Under the influence of secretions, inflammation develops in the head organ and in the membranes. Diagnosed with a disease – meningoencephalitis.
  • Inside the cranium, pus accumulates, provoking abscesses and sepsis.
  • Brain edema develops due to prolonged accumulation of cerebrospinal fluid in cerebral tissues.

Knowledge of the clinical picture characteristic of ear disease will help earlier diagnosis of pathology.

Middle ear cholesteatoma in some cases is a congenital pathology. The second name for congenital cholesteatoma is true. The capsule has a smooth surface, due to which the neoplasm has another name – “pearl tumor.” It develops due to embryonic failures. The capsule is located in the pyramid of the temporal bone.

False or acquired cholesteatoma occurs due to neglected or long-term otitis media. An ear injury may also be the cause. According to statistics, 90% of cases of the disease occur due to chronic otitis media of a purulent form.

Experts believe that the development of false cholesteatoma occurs in 2 ways:

  1. The proliferation of tissue of the ear canal into the middle ear through the rupture of the tympanic membrane.
  2. Violation of patency of the auditory tube due to the development of a disease such as eustachitis. The pressure in the tympanic cavity begins to drop, which causes the retraction of part of the tympanic membrane. The retraction becomes deeper, which provokes the accumulation of desquamated epithelium in it. Ultimately, a cholesteatoma develops.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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