One common cause of severe hearing loss is cholesteatoma. This is a neoplasm consisting of particles of a degenerated epithelium. Expanding, it blocks the middle ear cavity, causing unpleasant symptoms. When dull and oppressive ear pain, dizziness and fetid discharge appear, you should immediately contact an otorhinolaryngologist. Everyone knows what this is and what heals. In today's article, we will dwell in more detail on the features of the mentioned pathological process.
The essence of the disease
Cholesteatoma does not belong to the category of oncological diseases. It was first described in the 19th century, but has received its modern name recently. Only after a detailed study of the composition of the tumor, in which there is a lot of cholesterol, did the scientists introduce the corresponding term into medical practice. After some time, it was possible to determine the main causes of the disease, to choose effective methods of treatment.
Ear cholesteatoma is a white tumor that is encapsulated. It is formed by layers of keratinized cells overlapping each other. Sizes range from a few millimeters to 5-7 cm. The main components are protein compounds, keratin, lipoids and cholesterol. The neoplasm is covered with a matrix - a shell of connective tissue, which is tightly attached to the bone, and sometimes grows into it. During this process, the surrounding tissue is destroyed.
Causes of the disease and its pathogenesis
There are two forms of cholesteatoma of the ear:
- Congenital, or true. The appearance of the disease is due to embryonic developmental disorders of the fetus. The likelihood of its occurrence increases if a woman takes ototoxic drugs during pregnancy and is exposed to repeated x-rays. The neoplasm is usually localized in the pyramid of the temporal bone, less often in the lateral parts of the skull and one of the four ventricles of the brain.
- Acquired. The disease is diagnosed in adulthood. Predisposing factors for its development are chronic inflammatory pathologies of the ear (otitis media, eustachiitis), and traumatic injuries.
Modern medicine associates the occurrence of an acquired form of pathology with one of two mechanisms.
In the first case, pathogenesis implies a violation of the patency of the auditory tube against a background of eustachitis. The pressure in the tympanic cavity decreases, and part of the membrane is gradually drawn into it. Here, cholesterol crystals, desquamated epithelial cells and keratin begin to accumulate. Thus, the acquired ear cholesteatoma is formed.
In the second case, mechanical damage or chronic otitis media leads to tearing of the eardrum. A hole is formed between the external auditory meatus and the middle ear. Through it, the squamous epithelium grows into the tympanic cavity. A capsule of connective tissue limits the foreign substance, forming a cholesteatoma.
Clinical picture
In most cases, the middle ear cholesteatoma does not manifest itself with specific symptoms. This scenario is not found in all. Some patients consult a doctor with the following complaints:
- pain in the ear, characterized by a bursting character;
- discomfort in the temple or forehead;
- hearing impairment;
- the presence of discharge from the ear with impurities of pus, smelling unpleasant;
- nausea and severe dizziness.
With small sizes, the tumor cannot be visually examined. A large formation looks like a white curdled lump bulging through the external auditory canal.
In case of attachment of a secondary bacterial infection, the clinical picture is supplemented by symptoms of intoxication. Patients complain of a sharp increase in temperature, fatigue, weakness and loss of appetite. In the area of the affected ear, throbbing pain is possible.
Probable complications
If you ignore the symptoms of the disease and postpone treatment, it can lead to the development of complications. Among them, the following are recognized as the most common:
- Labyrinth fistula, accompanied by complete hearing loss.
- Paresis of the facial nerve.
- Sigmoid sinus thrombosis.
- Aseptic meningitis.
- Meningoencephalitis.
- Coma.
- Cerebral edema.
You should not be afraid of malignancy of the neoplasm. Elements of ear cholesteatoma are not tumor. They cannot uncontrollably share and spread through the body through the hematogenous route.
The danger of the pathological process lies in its proximity to the brain and nerve endings. The secretion secreted by the tumor makes these structures vulnerable. Therefore, meningitis, cerebral edema and other ailments develop rapidly, accompanied by pronounced symptoms. In the absence of quality medical care, they can be fatal.
Diagnostic Methods
If you suspect a cholesteatoma, you should contact your ENT specialist as soon as possible. Who is this and what this doctor treats, even small children know. If you go to an appointment with a local therapist, he will also give a referral to a specialist for a detailed diagnosis.
It begins with an external examination of the auditory meatus through an otoscope. With this device, you can detect inflammatory processes, identify the presence of pathological formations and changes in the structure of the eardrum. Then the patient is assigned a radiography. In the pictures, the tumor is clearly visualized, if it is present. An experienced doctor can evaluate its size and precise localization. However, computed tomography provides a more detailed picture.
Additional examination methods include:
- audiometry to check the hearing acuity of the patient;
- examination for sound perception by means of a tuning fork;
- vestibulometry - analysis of the functions of the vestibular apparatus.
The listed procedures can be completed today at any clinical center of otorhinolaryngology. Based on the results of a comprehensive examination, the doctor confirms or refutes the preliminary diagnosis, gives recommendations for eliminating the ailment. Today, the treatment of tumors is possible in two ways: conservative and surgical. They will be described in more detail below.
Conservative treatment
In the early stages, the disease can be eliminated by conservative methods. Usually resort to the aid of washing the drum space with a solution of boric acid or proteolytic enzymes. Manipulations must be repeated daily for one week.
If the standard procedure does not improve the patient's condition, you have to use a special cavity tube with a bend at the end. During the procedure, the doctor inserts it through an opening in the eardrum. With timely therapy, the discharge of pus from the ear ceases, and damaged tissue quickly regenerates.
Surgical intervention
When conservative methods do not allow to eliminate the pathology, surgical removal of cholesteatoma is recommended. Other indications for urgent surgery include:
- intracranial complications;
- osteomyelitis;
- paresis of the facial nerve;
- labyrinthitis;
- periodically inflamed polyps.
Only the most common cases where surgical removal of ear cholesteatoma is required are listed above. The operation is always prescribed individually, taking into account the clinical picture and the general health of the patient.
The procedure itself consists of several stages. First, the doctor removes the tumor formation. In order to exclude the repeated spread of the infectious process, he carries out sanitation of the cleaned cavity. In some cases, an eardrum plastic is additionally prescribed to restore its integrity.
Recovery after ear cholesteatoma removal
The consequences of the operation in the form of dizziness or nausea may accompany the patient for 7-10 days. Gradually, such symptoms disappear, additional medication is usually not required. Before discharge, the doctor must remove the sutures from the wound and apply a bandage. It is recommended to change it every few days until complete recovery. Physiotherapeutic procedures are sometimes prescribed to accelerate wound healing.
4 weeks after discharge, a follow-up examination is required. On it, the doctor usually checks the patient’s hearing. If a second operation is required, it can only be performed 6 months after the first. Otherwise, it will not be possible to avoid the development of complications.
Prevention Methods
Cholesteatoma does not belong to the category of oncological ailments. But this does not mean at all that its initial symptoms can be ignored, not to seek medical help. High-quality treatment always avoids the development of complications. Is it possible to prevent the appearance of this pathology?
Prevention of the disease primarily involves the timely treatment of all inflammatory processes affecting the ears. This is especially important for pregnant women and children. Ear cholesteatoma in a child is a fairly common phenomenon. Unfortunately, its development is often accompanied by local encephalitis and hydrocephalus.
Also, the prevention of the disease involves the strengthening of immunity. For this purpose, it is necessary to regularly use vitamin complexes, eat right and lead a healthy lifestyle. Do not forget about the hardening procedures and feasible sports.