Download Chronic Otitis Media/Cholesteatoma

PAUL E. HAMMERSCHLAG, MD, FACS
650 FIRST AVENUE
NEW YORK, NEW YORK 10016
(212) 889-2600
Chronic Otitis Media/Cholesteatoma
Chronic otitis media is a common cause of recurrent ear infections characterized by ear
drainage (otorrhea) and hearing loss. The otorrhea may be temporarily suppressed with
antibiotic therapy. Nevertheless due to irreversible changes in the middle ear and
mastoid mucosal lining, the diseased ear continues to be susceptible to infection. Surgery
is usually required to remove this diseased tissue to prevent recurrent infection.
Untreated chronic otitis media can lead to vertigo, tinnitus (ear noises), sensorineural
hearing loss in addition to conductive hearing deficits due to erosion of the middle ear
structures: tympanic membrane (ear drum), malleus, incus, and stapes (the little bones of
hearing). More extensive disease can be associated with facial paralysis, meningitis and
brain abscess.
Cholesteatoma is an abnormal accumulation of skin found in the middle ear and/or the
mastoid. The periphery of cholesteatoma incites an inflammatory reaction of the adjacent
bone of the mastoid and middle ear cleft. This inflammatory enzymatic reaction can lead
to soft tissue bone destruction. If untreated, cholesteatoma will eventually erode the
middle ear structures (little bones of hearing), the labyrinth (the inner ear) to cause loss of
hearing, dizziness or vertigo and facial paralysis. Chronic infections associated with
cholesteatoma can ultimately cause life threatening meningitis and brain abscess.
Treatment of cholesteatoma and chronic otitis media is with surgical removal of disease
(tympanomastoidectomy) with the intent to create a safe dry ear in which cholesteatoma
and chronic otitis media do not recur. After these first two goals are met, the hearing
may be restored with middle ear and ossicular (little bones of hearing) reconstruction.
The extent of the middle ear and mastoid destruction by chronic otitis media and/or
cholesteatoma will adversely affect the degree of hearing restoration: the more severe the
underlying disease, the less likely normal hearing will be achieved or maintained over the
long term. Good eustachian tube function, which provides middle ear aeration, is another
factor that contributes to successful long term hearing restoration.
Your otologist can discuss the various surgical options and reconstruction strategies that
is best for your particular situation. For example, the hearing reconstruction may be
delayed to maximize middle ear anatomical stability after several months to ensure a
more precise reconstruction. A second “stage” surgery also will facilitate reinspection of
the operative site for persistent cholesteatoma if there is concern about incomplete
disease removal at the first stage. (Sometimes initial complete disease removal may
damage important structures in the middle ear). Removal of residual disease may be less
risky after the clearance of adjacent inflammation following the first stage.
As noted earlier, the longterm prevention of cholesteatoma and chronic otitis media and
the maintenance of hearing stability may depend of effective eustachian tube function as
well as the extent of disease destruction at the time of surgery. The eustachian tube
normally provides aeration of the middle ear cleft. When the eustachian tube functions
poorly, negatively aerated middle ear space occurs. The negative pressure affect, not
unlike a vacuum, may cause inward displacement of the skin lined tympanic membrane
(ear drum) which can lead to reformation of chronic otitis media and cholesteatoma.
Patients who have had surgery for cholesteatoma/chronic otitis media should be followed
at least on an annual basis (for the rest of their lives) by an otologist to monitor for
possible of recurrence of disease and ensure stability of auditory function. If there is an
open mastoid cavity, it needs to be cleaned of accumulated dead skin every several
months because the wax secreting glands found in the normal ear canal skin may not be
present in the skin lining the mastoid cavity.