Cholesteatoma: When is mastoid surgery necessary?

Cholesteatoma is a serious condition affecting the middle ear that requires careful management and, in many cases, surgical interventions like mastoid surgery.

Professor Vikas Malik, leading ENT surgeon, provides an expert insight into cholesteatoma and mastoid surgery, discussing the indications for surgery, how the procedure is performed, and the recovery process.

What is cholesteatoma?

Cholesteatoma is an abnormal skin growth that forms in the middle ear, typically behind the eardrum. It occurs when skin cells become trapped in the middle ear, creating a skin growth that starts growing uncontrollably.

The symptoms of cholesteatoma can vary depending on the size and location of the skin growth. Signs commonly include:

• chronic ear infections
• foul-smelling ear discharge
• hearing loss
• ear pain, fullness, or pressure
• dizziness or balance problems

Over time, the cholesteatoma can damage the ear's structures, including the bones and eardrum, leading to more severe complications.

When is mastoid surgery needed for cholesteatoma?

There are several scenarios where mastoid surgery becomes necessary:

• Severe hearing loss: If the cholesteatoma damages the ossicles (the small bones in the middle ear that transmit sound).
• Chronic ear infections: If the cholesteatoma causes persistent ear infections that don’t improve with antibiotics.
• Facial nerve involvement: If the cholesteatoma presses on the facial nerve, it can cause facial weakness or paralysis.
• Spread of infection: If the cholesteatoma has become large, infected, or is at risk of spreading to surrounding areas like the inner ear or even the brain.

Mastoid surgery can also help improve the chances of preserving or restoring hearing if the condition is addressed early.

How is mastoid surgery for cholesteatoma performed?

There are different types of mastoid surgery, and the approach may vary depending on the size and location of the cholesteatoma, and whether additional repairs are needed.

Typically, your ENT surgeon will start by making an incision behind the ear, where the mastoid bone is located. Next, your surgeon will carefully access the mastoid bone to reach the middle ear and remove the cholesteatoma. The cholesteatoma and any infected or damaged tissue will then be removed.

In some cases, part of the mastoid bone may need to be removed. Depending on the extent of the damage, your surgeon will also reconstruct the eardrum or the ossicles to help restore hearing function with the use of a graft or prosthetic devices.

Lastly, the incision will be closed with stitches, and a dressing will be applied to the ear.

What is the recovery process like?

Immediately following the surgery, you may experience mild discomfort, swelling, and some draining from the ear. These symptoms are temporary and will improve over time as the ear heals. Any pain can usually be managed with prescribed medications.

During the recovery period, you will need to keep the ear dry and avoid activities like swimming or heavy lifting for a few weeks. Most patients can resume normal activities after 4 to 6 weeks, although full recovery can take several months, depending on the extent of the surgery.

Most importantly, it’s essential to attend follow-up appointments with your surgeon to monitor the healing process and check for any signs of complications or recurrence of the cholesteatoma. Your surgeon will also perform hearing tests to assess any improvements in hearing after surgery.

Will my hearing improve after mastoid surgery for cholesteatoma?

Mastoid surgery can significantly improve hearing in many cases, especially if the ossicles and eardrum weren’t severely damaged. However, the degree of hearing improvement will depend on several factors, including the severity of the damage before surgery.

For patients who have significant hearing loss due to extensive damage, additional treatments such as hearing aids or cochlear implants may be recommended.

If you would like to book an appointment with Professor Vikas Malik, head on over to his Top Doctors profile today.