1) Congenital - These are cholesteatomas that occur because the skin like squamous tissue gets trapped behind the eardrum abnormally during development before birth. They usually are identified early in childhood. A child with chronic ear infections may potentially have a cholesteatoma, particularly if the infections are always in the same ear.

2) Acquired - These are cholesteatomas that occur usually because of chronic ear infections, a hole in the eardrum, eustachian tube dysfunction which produces pressure symptoms in the ear, or from trauma. Typically the cholesteatoma begins as a retraction pocket within the tympanic membrane. Due to abnormal negative pressure behind the eardrum the eardrum gets sucked inward creating a deep pocket. Debris collects within this pocket resulting in chronic infections.

Regardless of whether the cholesteatoma is congenital or acquired, the potential risks are the same. The cholesteatoma can destroy the bones of the middle and inner ear resulting in hearing loss and dizziness. It can also cause chronic infections in the middle ear which can lead to serious complications including meningitis and death if not surgically removed.

Treatment of Cholesteatomas

THE TREATMENT OF CHOLESTEATOMAS IS COMPLETE SURGICAL REMOVAL. This involves a surgery called a mastoidectomy and tympanoplasty. In most cases the treatment of a cholesteatoma without surgery is inappropriate and exposes the patient to the risks described above.

The primary goal of surgery is to remove the entire cholesteatoma in order to protect the ear from continued damage. This may result in a permanent hearing loss, especially with advanced cholesteatomas. However, the secondary goal of surgery is to restore hearing. Often the ear can be reconstructed at the same time the cholesteatoma is removed. (See Ossicular Reconstruction Page)

Once the surgery is completed the patient should be followed closely by the surgeon in order to monitor the patient's ear for recurrence of the lesion. Recurrence rates can be as high as 20%.

At Berks ENT Surgical Associates techniques have been developed which can substantially decrease the risk of recurrence. Prevention of a recurrence and preservation of hearing are two factors we heavily focus on during our surgical planning. Our surgeons have extensive experience in dealing with cholesteatomas with a history of excellent surgical outcomes and patient satisfaction.

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