When I was about nine years old, I experienced tremendous pain in my left ear. My mother took me to the doctors office and he diagnosed me with an ear infection. After many attempts at irrigating my ear with peroxide and a few hours of dizziness later, I was sent home with what would be the first of many years of prescriptions for what was diagnosed at the typical childhood ear infection. Years later as a teen, I saw my first ENT. He also treated my infection as normal. It wasn't until twenty years later when my mothers eardrum burst that she was diagnosed with a cholesteatoma. Her doctor explained to her that this could have been an acquired infection or a congenital one. I had one of the docs at the ER where I worked to take a look and sure enough, he suspected the same for me. It was congenital.
What is a cholesteatoma you might ask. The middle ear like everything else shed a dead layer of skin as new cells are forming. With the normal process the skin moves outward, but with a cholesteatoma, it moves inward into the middle ear or mastoid process. This expanding growth of skin can sometimes contain cholesterol crystals and even worse, an infection know as Pseudomonas Aeruginosa. This combination will wreak havoc on the middle ear eating away the 3 tiny bones in the ear and can even move into the brain tissue. The end result of this can be nerve deterioration, deafness, vertigo, and more importantly meningitis, brain abscess and even death.
Until it becomes infected is it usually diagnosed incorrectly. Most general practitioners do not see these cases, but maybe one in every 10 to 20 years. Even highly skilled ENT's have missed cholesteatomas before. Sometimes they cannot be seen but with a high powered surgical microscope, unless the surgeon knows exactly where to look. The classic sign for a cholesterol tumor is what is know as the attic crust or brown flake of dried skin located at the top of the eardrum. Symptoms can include dizziness, stiff neck, headache, hearing loss, a brown, yellow, or bloody discharge from the ear canal usually accompanied with a foul smelling odor. If you have these symptoms ask your doctor if this could possibly be the cause, especially if you keep experiencing reoccurring infections. Getting water is the ear via showers or swimming only adds to the infection and discharge. The goal is to create a dry environment for the ear canal.
The only cure for a cholesteatoma is surgery. Topical drops and oral medications or injections will fight the infection and inflammation, but a mastiodectomy is necessary to remove the cholesteatoma. The doctor can also perform a tympanoplasty to repair or replace damage structures in the eardrum. Usually the rebuilding comes later with a second surgery after determining the the entire cholesteatoma has been successfully removed. Unfortunately 10 to 20 percent will reoccur. I have had both surgerys twice and I still have an ear infection. Hopefully the art of removal will improve with the everychanging technological advances in medicine. Just remember, the next time you suffer from a reoccuring infection, ask your doctor if your ear infection could be a cholesteatoma.