Can Cholesteatoma Lead To Permanent Deafness?

Introduction

Definition of cholesteatoma

The abnormal buildup of dead skin cells, waste materials, and fluids inside the ear results in cholesteatoma. It usually occurs due to recurring ear infections or problems with the eustachian tube; the throat and ear are connected via the eustachian tube. The eustachian tube helps in the maintenance of ear pressure or equilibrium. Any defect in this tube can be due to allergic infections, common cold conditions, or sinus problems. The abnormal growth can cause damage to the surrounding structures in the ear and lead to symptoms like hearing loss, ear pain, discharge, and dizziness. Surgery is often necessary to remove the cholesteatoma and prevent further complications.

Causes and symptoms of cholesteatoma

Causes of cholesteatoma

Cholesteatoma, an abnormal buildup of dead skin cells and fluids in the ear can be caused by various factors. The two main types of cholesteatoma are congenital (present at birth) and acquired (developed later in life). Cholesteatoma often affects one ear, occurring in the middle ear due to recurring ear infections or problems with the tube that connects the ear to the throat.¹  

Congenital cholesteatoma is believed to occur due to abnormal development in the ear during foetal growth. It is not clear why some individuals are born with this condition, but it is thought to be related to genetic or developmental factors.

Acquired cholesteatoma, on the other hand, is typically associated with recurring ear infections or problems with the eustachian tube. When the eustachian tube malfunctions, it can result in an imbalance of pressure in the middle ear, leading to the accumulation of debris and fluids. This creates an environment conducive to the formation of cholesteatoma.

Factors that can contribute to acquired cholesteatoma include chronic or untreated ear infections, previous trauma or injury to the ear, chronic inflammation of the middle ear, and anatomical abnormalities in the structure of the ear. All of these conditions can disrupt the normal flow of fluids in the ear and promote the growth of cholesteatoma.

It's important to note that cholesteatoma is not contagious and cannot be spread from person to person. Understanding the causes of cholesteatoma is crucial for proper diagnosis and treatment, as early intervention can help prevent complications and preserve hearing health.

Symptoms of cholesteatoma, including hearing loss

• One common symptom of cholesteatoma is a persistent, foul-smelling discharge from the infected ear. This discharge may be watery or contain pus, and it is often accompanied by a feeling of fullness or pressure in the ear
• Loss of sensation in the ear, particularly hearing. Hearing loss is another significant symptom of cholesteatoma. As the abnormal growth expands and damages the surrounding structures, it can interfere with the transmission of sound waves, leading to a gradual or sudden decline in hearing ability
• Vertigo, a feeling that the environment around is rotating. Vertigo, characterised by a spinning or dizzy sensation, can also occur due to cholesteatoma. This symptom is caused by the disruption of the inner ear's balance mechanisms, which can be affected as the growth expands and affects the delicate structures involved in balance regulation
• Additionally, individuals with cholesteatoma may experience ear pain or discomfort, which can range from mild to severe. The pain is often associated with the inflammation and pressure caused by the abnormal growth within the ear

Complications of cholesteatoma

Cholesteatoma, an abnormal growth of skin cells and fluids in the ear, can lead to several complications if left untreated. These complications can vary in severity and have the potential to affect different parts of the ear and surrounding structures.

• An ear infection is one common complication that results in drainage from the ears. The cholesteatoma can trap bacteria and debris, creating a favourable environment for infection. This can result in frequent episodes of ear inflammation, pain, and discharge
• Hearing loss, the inability to hear anything is another significant complication. This may last forever. As the cholesteatoma grows, it can damage the delicate structures of the ear involved in hearing, such as the ossicles and the cochlea. This can lead to varying degrees of hearing impairment, ranging from mild to profound deafness
• Injury to your facial nerve, which can result in paralysis in half of your face. In some cases, cholesteatoma can cause injury to the facial nerve, which controls the movement of the facial muscles. This can result in paralysis or weakness on one side of the face, leading to facial drooping or difficulty in facial expressions
• Tinnitus is the sense that sound is heard within the body, than outside. Tinnitus, a ringing or buzzing sound in the ears, particularly a tingling sensation, can also occur as a complication of cholesteatoma. This phantom noise can be persistent and bothersome, affecting the quality of life for individuals with this condition
• A brain cyst or meningitis can result from an infection that, in rare instances, the cholesteatoma can lead to more serious complications, and spreads to the inside of the ear and brain
• Sigmoid sinus thrombosis, it can also result in sigmoid sinus thrombosis, a blood clot in the major vein draining blood from the brain, or an epidural abscess, a collection of pus between the skull and the protective covering of the brain
• Epidural abscess, when the infection reaches the epidural space, it can lead to the formation of an epidural abscess. This is a collection of pus that puts pressure on the brain and spinal cord. The abscess can cause symptoms such as severe headache, neck stiffness, fever, neurological deficits, and changes in consciousness

 It is essential to seek medical attention if cholesteatoma is suspected to prevent these complications. Early diagnosis and appropriate treatment can help manage the condition and reduce the risk of long-term complications.

Can cholesteatoma lead to permanent deafness?

The buildup of tissue in the middle of the ear may injure surrounding tissues and result in a variety of complications. The hearing impairment brought on by the middle ear structures eroding constitutes one of the most prevalent issues. 

As the cholesteatoma grows, it can erode and destroy these important structures, resulting in a gradual or sudden decline in hearing ability. The extent of hearing loss can vary depending on the severity and duration of the cholesteatoma.

In addition to direct damage to the hearing structures, cholesteatoma can also lead to complications such as recurrent ear infections and inflammation. These conditions can further contribute to hearing loss over time.

Early detection and prompt treatment are crucial to prevent permanent hearing loss associated with cholesteatoma. Surgical intervention is often necessary to remove the cholesteatoma and repair any damage to the affected structures. However, even with appropriate treatment, the degree of hearing recovery may vary, and some individuals may experience permanent hearing impairment.

Therefore, it is important for individuals experiencing symptoms of cholesteatoma, such as hearing loss, ear pain, or discharge, to seek medical attention promptly. Timely intervention can help preserve hearing function and prevent long-term complications

Treatment options for cholesteatoma

It is quite challenging to treat cholesteatomas after they have become inflamed. The most recommended treatment is the removal of noncancerous cysts by surgery, this may not restore the patient’s hearing to normal.²  In fact, the patient’s hearing could decline after surgery. The probability of recurrence is significantly greater when using the wall-up approach. 

Intravenous antibiotics cannot penetrate the tumour's centre since the lesion lacks blood circulation. Topical medicines can only treat surface infections, thus ear discharge persists or comes back often.³

Summary

Cholesteatoma is an abnormal buildup of dead skin cells and fluids in the ear, often caused by recurring ear infections or issues with the eustachian tube. It can lead to symptoms like hearing loss, ear pain, and discharge. If left untreated, cholesteatoma can result in complications such as infection, facial nerve injury, and even rare conditions like brain cysts or meningitis. Surgery is typically required to remove the cholesteatoma, but it may not fully restore hearing and can sometimes lead to further hearing decline. Intravenous antibiotics and topical medications may help manage the infection but cannot fully penetrate the cholesteatoma.