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Cholesteatoma is a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. [1] [2] Cholesteatomas are not cancerous as the name may suggest, but can cause significant problems because of their erosive and expansile properties.
A mastoidectomy is a procedure performed to remove the mastoid air cells [1] near the middle ear. The procedure is part of the treatment for mastoiditis, chronic suppurative otitis media or cholesteatoma. [2] Additionally, it is sometimes performed as part of other procedures, such as cochlear implants, [3] or to access the middle ear.
Whilst hearing loss is a common symptom in many diseases of the ear, for example in otosclerosis (abnormal bone growth in the ear), [3] the white, chalky patches on the tympanic membrane are fairly characteristic of tympanosclerosis. Cholesteatoma is similar in appearance but the whiteness is behind the tympanic membrane, rather than inside.
If the patient fails first line antibiotics, then second-line therapies should be employed, especially after appropriate culture and sensitivity testing. Surgery may be required if there is extension into the mastoid bone, or if a concurrent cholesteatoma is identified during surgery or biopsy.
Tympanoplasty is the surgical technique of removal of the retracted area from the middle ear and reconstruction of the tympanic membrane. Some surgeons use cartilage (taken from the outer ear) to stiffen the eardrum with the aim of preventing further retraction. [9] Surgical removal is required once a cholesteatoma has formed.
video link: Aural/Ear syringe: used to flush out anything like ear wax or foreign bodies from the external ear Toynbee's auscultation tube: Otoscope/Auriscope: to examine the external auditory canal and ear drum; used during aural toileting, removal of wax, myringotomy, stapedectomy and to dilate the stenosis of canal Mouth gag - •Doyen's ...
Prolonged duration of otitis media is associated with ossicular complications and, together with persistent tympanic membrane perforation, contributes to the severity of the disease and hearing loss. When a cholesteatoma or granulation tissue is present in the middle ear, the degree of hearing loss and ossicular destruction is even greater. [75]
The endoscope allows the surgeon to look around the corners and to reach inaccessible areas like the sinus tympani through the ear canal. [9] Endoscopic ear surgery utilizes the ear canal as the access point for removal of cholesteatoma and therefore represent a minimally invasive alternative to traditional surgery that requires large incision ...