The middle ear is the space behind the ear drum. Three tiny bones function together inside the middle ear for hearing. The Eustachian tube---responsible for draining fluid from the sinuses and releasing air pressure---is also part of the middle ear. A cholesteatoma is a slow growing tumour in the middle ear that can go undetected for many years. Middle ear tumours can be present at birth, or develop later in life. Most middle ear tumours present no symptoms until damage has occurred to hearing and balance structures in the ear.
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Cholesteatomas are the most common tumours or growths that originate in the middle ear. Cholesteatomas are benign cysts---not cancer. Tumours from the brain, outer or inner ear, jaw, face, or neck can grow and invade the middle ear, but are not considered a true "middle ear tumour." In a study done by the Division of Otolaryngology, Tripler Army Medical Center, Honolulu, HI USA in September 2005, only 46 published cases of malignant middle ear tumours existed, such tumours are referred to as carcinoid and adenoma growths---considered to be very rare low-grade malignant tumours.
Middle ear lesions are believed to be the cause of malignant tumours. According to the Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, middle ear lesions are rare and all middle ear tumours should be considered malignant until otherwise diagnosed. Cholesteatoma tumours can develop from a tear in the ear drum, or multiple infections that have damaged the ear drum and middle ear. Normally a tear or hole in the ear drum will heal on its own; however, if an infection develops while the perforation is healing the skin continues to grow into the middle ear forming a benign cyst. According to the American Academy of Otolaryngology, poor eustachian tube function and middle ear infections can also cause cholesteatoma's. The eustachian tube equalises ear pressure by letting air flow back and forth between the nose and middle ear. Colds, allergies, and sinusitis cause the eustachian tube to work poorly. If air in the middle ear gets absorbed by the body a vacuum is created and the pressure sucks in on the eardrum forming into a sac and becoming a cholesteatoma. Cholesteatoma's found growing behind the ear drum with no signs of trauma to the ear drum and no history of reoccurring ear or sinus infections, are thought to be congenital---present since birth. Congenital cholesteatoma's are very rare.
According to the American Academy of Otolaryngology, as a cholesteatoma cyst or sac enlarges, it can cause a feeling of fullness or pressure in the ear, along with hearing loss, and an ache behind or in the ear, especially at night. If you experience ear discharge with a foul odour, bleeding from the ear, dizziness, loss of balance, headaches or ringing in the ear these could all be symptoms of a middle ear tumour. Severe pains, sudden loss of hearing, and facial muscle weakness or drooping on one side of your face are signs of an enlarging cholesteatoma.
A cholesteatoma is a serious condition that requires prompt diagnosis and treatment. When your doctor examines your ears granulated tissue, discharge, and scaly layers of skin may be visible signs of a tumour. According to Drs. Charles Beatty, and Cynthia Hogan, from the Mayo Clinic in Rochester Minnesota, a C.T. scan should be done to help determine the extent of the growth and how much the bones within the middle ear have been affected. If you suspect a cholesteatoma the American Academy of Otolaryngology recommends an examination by an otolaryngologist---head and neck surgeon to confirm the presence of a cholesteatoma. Hearing and balance tests along with X-rays of the skull bone next to the ear help determine how much damaged the cholesteatoma has caused.
According to the Mayo Clinic, initial treatment of a cholesteatoma often involves antibiotics and eardrops to treat any infection and stop any drainage. Usually surgery is required to remove the cyst, clear infection and repair damage to structures within the ear. Depending on size; tumours are removed through the ear canal or from an incision behind the ear. According to the American Academy of Otolaryngology, a second operation may be needed 6 to 12 months later to reconstruct the middle ear, attempt to restore any lost hearing, and check for residual cholesteatoma in the middle ear space. In cases involving large tumours and severe ear destruction, reconstruction of the middle ear may not be possible. Surgery can often be done on an outpatient basis. One to two weeks of rest is recommended post surgery. After surgery follow-up care is important to check for recurrences and help prevent middle ear infections.
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