Cholesteatoma, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

This book describes Cholesteatoma, Diagnosis and Treatment and Related Diseases
Cholesteatoma is a form of skin cyst that is located in the middle ear and mastoid bone in the skull.
This lesion is incorrectly named, as it is not exactly a tumor nor is it made of cholesterol but rather it is a three-dimensional collection of epidermal and connective tissues within the middle ear.
Its importance lies in the fact that it grows independently and can be locally invasive and destructive, mainly affecting the bones of the middle ear.
Bone erosion happens mainly by pressure but release of osteolytic enzymes has been identified at the peripheral margins of the lesion.
Osteolytic activity seems to be enhanced by the presence of infection.
The (normally) unilateral lesion can give rise to a spectrum of disorders, ranging from painless otorrhoea (discharge from the ear) through to serious central nervous system complications.
Classification
Congenital cholesteatoma
This happens when squamous epithelium becomes trapped within the temporal bone during embryogenesis.
It enlarges, resulting in conductive hearing loss either through blockage of the Eustachian tube or by enclosing the ossicular chain.
Primary acquired cholesteatoma
It is thought that chronic negative middle-ear pressure because of an abnormal function of the Eustachian tube causes the tympanic membrane to be 'sucked back' and retract.
As this process persists, there is erosion of the lateral wall of the epitympanum , producing a slowly enlarging defect.
A pocket covered by squamous, non-keratinizing epithelium is then formed.
The erosion often persists, as the ball of epithelium grows, to enclose the ossicles and may spread into the mastoid bone, lateral semicircular canal, middle and posterior cranial fossa.
Secondary acquired cholesteatoma
This happens as a result of injury to the tympanic membrane, such as perforation due to acute otitis media (AOM) or damage, or because of surgical manipulation of the drum.
Squamous epithelium may be unintentionally implanted by the injury so activating the process of cellular growth leading to cholesteatoma formation.
Symptoms:
1.Dizziness
2.Drainage from the ear, which can be chronic
3.Hearing loss in one ear
Small lesions are linked with a progressive conductive hearing loss but, as the lesion grows and erodes into adjacent structures, there may be other features such as vertigo, headache and facial nerve palsy.
Diagnosis:
An ear exam may show a pus pocket or perforation in the eardrum, often with drainage.
A deposit of old skin cells may be visualized with an otoscope
1.Hearing to detect loss
2.CT imaging for option of surgery
Treatment
Cholesteatomas very often persist to grow if they are not resected.
Surgery is most often successful.
Medical treatment is reserved for those patients who refuse surgery or for whom a general anesthesia would be too hazardous owing to co-morbidity.
In these patients, regular ear cleaning with treatment of infections (topical ± systemic antibiotics) is advised
Surgical treatment
The purpose of surgery is to remove the cholesteatoma.
Surgery involves a general anesthesia and an incision behind the ear and in the auditory meatus.
There are two methods utilized:
1.Open technique (tympanomastoidectomy): this is a longer and more involved operation that involves removal of a number of structures
This is the more successful of the two types of procedure in terms of cholesteatoma removal and hence a single procedure is normally sufficient.
2.Closed technique (tympanoplasty): this method is linked with a better end result with regards to cosmetic appearance
There is a higher risk of persistent or recurring cholesteatomas

TABLE OF CONTENT
Introduction

Dettagli