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If the cholesteatoma has been dry, the cholesteatoma may present the appearance of 'wax over the attic'. The attic is just above the eardrum. If untreated, a cholesteatoma can eat or cause erosion of the three small bones located in the middle ear (the malleus, incus and stapes, collectively called ossicles). [5]
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.
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.
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.
Some mastoiditis is caused by cholesteatoma, which is a sac of keratinizing squamous epithelium in the middle ear that usually results from repeated middle-ear infections. If left untreated, the cholesteatoma can erode into the mastoid process, producing mastoiditis, as well as other complications. [4]
By gross description, there is usually a solitary, polypoid, reddish mass behind an intact ear drum (tympanic membrane). The tissue is often friable, measuring <2 cm in most cases. All tissue should be processed in order to exclude a concurrent cholesteatoma.
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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]