Cholesteatoma
A cholesteatoma is a benign cyst that grows in the ear. Most cholesteatomas occupy the middle ear space, which is behind the tympanic membrane (eardrum). Some occur in the external ear canal, and they are referred to as canal cholesteatomas. Cholesteatomas typically occur in children and adults who have chronic eustachian tube dysfunction (ETD), a problem with ventilating or “popping” the ears. When ETD is present for many years, it can lead to development of a cholesteatoma. Although most cholesteatomas are acquired, some patients are actually born with the cholesteatoma; this is called a congenital cholesteatoma.
Cholesteatomas usually grow very slowly, but they cause damage to any structure in the ear that they come in contact with. This can lead to infection, chronic ear discharge, ear pain, hearing loss, dizziness, facial paralysis, or in the rarest cases brain injury. Due to the seriousness of these complications, cholesteatomas need to be surgically removed. The operation is called a mastoidectomy, and the goal is to remove the entire cholesteatoma and, if possible, reconstruct the hearing. Following surgery, patients are usually seen on a regular basis to clean the ear and make sure the cholesteatoma does not return.
Mastoidectomy is a typically an elective surgical procedure; that is, scheduled at the patient’s convenience. Occasionally, an emergency mastoidectomy is done for patients with acute mastoiditis, a severe ear infection that can lead to serious or even life-threatening complications.
Mastoidectomy is a typically an elective surgical procedure; that is, scheduled at the patient’s convenience. Occasionally, an emergency mastoidectomy is done for patients with acute mastoiditis, a severe ear infection that can lead to serious or even life-threatening complications.
Surgical risks
The risks of mastoidectomy with or without tympanoplasty will be discussed at the preoperative visit and should be completely understood by the patient prior to surgery.
Bleeding: Bleeding is usually insignificant during this ear surgery. If significant bleeding was to occur, then the procedure is terminated.
Infection: Immediate postoperative infection or early postoperative infection is rare. You will likely be given a preoperative and postoperative antibiotic. Local infection with drainage in a healed canal‐wall‐down mastoid cavity is relatively common. This typically requires topical antibiotics and/or antiseptics, frequent in‐office local wound care visits, and on occasion, oral antibiotics. On occasion, revision surgery is needed.
Recurrent Disease: Both cholesteatoma and chronic infection can recur. This may lead to an unplanned or planned revision surgery months or years later. As an example, the risk of recurrent cholesteatoma in a canal‐wall‐ up procedure is reported as high as 40‐60%.
Hearing loss: Your hearing may not change with the surgery. On occasion, we can improve your hearing by rebuilding the middle ear bones (ossiculoplasty or ossicular chain reconstruction). Your surgery carries a <1% chance of completely losing the hearing in the ear that is to have the surgery. There is a chance of the hearing being worse than before the surgery. When the surgery is being performed for cholesteatoma, hearing restoration or improvement is actually thought of as a secondary goal with the primary goal to remove the disease. Sometimes purposefully the hearing is temporarily worse after the first surgery with the plan to attempt hearing restoration at the ‘second-look’ procedure 9-15 months later.
Tinnitus: There is a small risk of causing tinnitus (ringing in the ear) with your surgery or making it worse if you had tinnitus pre‐operatively.
Ear position: During healing your ear may protrude out more or be closer to your head. This is usually temporary, but if permanent, can be revised surgically at a later date to improve ear position.
Facial nerve injury: During surgery, we monitor the function of your facial nerve. There is a <2% risk of injuring the facial nerve. This nerve controls the facial muscles on the side of surgery. Injury to this nerve can cause paralysis and drooping of the muscles on that side of your face. If there is injury, surgical repair would be performed; however, normal mobility of the face would not be expected.
Taste change: There is a small nerve that runs in your middle ear that often needs to be removed to adequately treat your cholesteatoma or chronic infection. You may experience a metallic taste in your mouth for several months. This would dissipate over time. It is generally not a problem.
Cerebrospinal fluid leak: The top of the mastoid and middle ear borders a portion of the brain. There is a very small risk of injury to the covering of the brain, which would lead to leak of “spinal fluid” out your ear. If this occurs, this would require further surgery for repair. If this occurs in surgery, a repair would be performed at that time. Untreated, this injury would make you susceptible to meningitis.
Brain injury: The brain lies within millimeters of the mastoid cavity. If injury was to occur, this is not repairable.
Anesthesia risks: As with any type of surgery, the risks of anesthesia such as drug reaction, breathing difficulties and even a very remote chance of death are possible. Please discuss these risks with your anesthesiologist.
