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What is a Cholesteatoma?

A cholesteatoma is a growth in the eardrum. It is non-cancerous in nature but can cause a slew of problems. A cholesteatoma usually begins as a cyst that sheds layers of dead skin. Over time, the dead skin builds up and can cause damage to the eardrum or the hearing bones, so it is important to get it taken care of.

What Causes a Cholesteatoma?

A cholesteatoma can be caused by several different things. The most common cause of a cholesteatoma is repeated middle ear infections. Another cause of a cholesteatoma is the malfunctioning of the eustachian tubes (the tubes that connect the back of the nose to the ears). The purpose of these tubes is to equalize the pressure on both sides of the eardrum. Sinus infections, ear infections, allergies, and colds all may cause the eustachian tubes to not function properly.

What Are the Symptoms of a Cholesteatoma?

The symptoms of a cholesteatoma are mild at first but worsen as the intermittent discharge builds up in the ear. The ear may start to drain a foul-smelling odor. When there is more discharge, it will begin to put pressure inside the ear which can be uncomfortable and even cause a hearing loss. Other symptoms include tinnitus (ringing in the ears) and dizziness. It’s important to see a doctor if you are having any of these symptoms so the problem can be taken care of right away.

How is a Cholesteatoma Treated?

A cholesteatoma is treated with surgery since that is the only way to remove the cyst. Prior to surgery, patients are given antibiotics and ear drops to treat the infected cyst and prepare it for removal. The removal process (tympanoplasty with mastoidectomy) is a simple procedure under general anesthesia, and most patients go home right away. Often a second surgery will also be scheduled to repair any damage that the cyst caused to the middle ear and to ensure that the cyst was fully removed.

Can a Cholesteatoma be Prevented?

Tubes are placed in the ears to prevent cholesteatomas. Taking care of ear infections as soon as they happen is another preventative measure that can be taken. If there is a family history of cholesteatomas, it cannot be prevented. In this situation, parents should keep a close watch on their children to be on the lookout for the symptoms of a cholesteatoma. It is much better to catch it while the cyst is still small.

Tympanoplasty with Mastiodectomy

A tympanoplasty is an ear surgery that repairs a hole in the eardrum or fixes the bones of hearing. The surgery itself takes about an hour to an hour and a half. It’s an outpatient surgery so you’ll go home that day. Patients typically rest at home for 2-3 days before returning to work. The hearing doesn’t come back instantaneously, however. It gradually returns over 2-3 months.

What Causes the Need for a Tympanoplasty?

A hole after tubes is the most common reason a patient might get a tympanoplasty. A hole in the eardrum can cause a patient to have repeat infections or a hearing loss. The loss is called a conductive hearing loss. Additionally, patients that have a hole in the eardrum should avoid getting water in the ear to prevent infections.

What to Know Before the Surgery

Don’t eat anything after midnight on the morning of your surgery. Why? For this surgery, you will be put under general anesthesia. If you were to vomit while under anesthesia, it could enter your lungs and cause many problems.

Remove all makeup prior to your surgery.

What Happens During the Surgery?

You will be put under general anesthesia, and the ear will be cleaned and prepped before surgery.

At the start of surgery, the surgeon will make a C-shaped cut around the back of the ear. At Arizona Hearing Center, we refer to it as a “barber’s incision” or “hairdresser incision” since only your barber or hairdresser will look behind your ears. The surgeon will then flip your ear over. Through the incision, the surgeon cuts out a small piece of dense, fibrous chewing muscle above your ear.

The surgeon will then move to your ear canal. Then he will expose the ear canal and eardrum by pulling the skin away from the canal and sometimes widen the canal if it is too narrow.

Once the eardrum is visible, the surgeon will roughen up the edges of the eardrum to remove scar tissue and promote healing.

Through that hole, the surgeon will tap the bones of hearing to check that they are properly functioning. If they are not, the surgeon may fix the bones or insert prosthetic bones while the eardrum is still open.

Next, the surgeon will remove the infection or growth behind the bone behind the ear(mastoid bone).

Packing made of dissolvable material will be put behind the perforated eardrum, in the middle ear. Then the tissue will be placed flush against the existing eardrum, propped up by packing inside the middle ear. More of the packing is placed in front of the tissue so that the tissue is held down from both sides.

Lastly, the surgeon will flip the ear back over, fill the ear with packing, and place stitches along the incision.

During the follow-up appointment, the packing outside the eardrum will be removed. The hearing in that ear may take a few months to come back since the packing inside the eardrum has to dissolve for the ear to function again.


Post-Operative Instructions

This information will help you care for the surgical site and answer frequently asked question about the procedure.

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