The ear, as an important organ of the human body, often encounters various problems. Diseases such as middle ear cholesteatoma are quite common among people. What should one do if they are diagnosed with middle ear cholesteatoma? Understanding what middle ear cholesteatoma is, its causes, symptoms, and treatment methods is crucial for patients. So, what exactly is middle ear cholesteatoma? Please find the detailed explanation below.
Middle ear cholesteatoma is an abnormal accumulation of keratin-producing squamous epithelium, often occurring in the middle tympanic cavity, attic, mastoid, or petrous apex. Due to the progressive destruction of middle ear hearing structures and adjacent skull bones presented by cholesteatomatous otitis media, it often leads to serious adverse consequences. Cholesteatoma not only impairs hearing but also causes increasingly severe invasion and damage, ultimately potentially resulting in facial nerve lesions, facial paralysis, vestibular lesions, vertigo, intracranial infections, brain abscesses, and other highly harmful complications. Therefore, surgical treatment should be considered upon diagnosis.
Based on different causes, cholesteatoma can be divided into two categories: 1. Congenital cholesteatoma, which originates from the same ectoderm that forms the primitive notochord. This residual ectodermal embryonic cell can occur in any part of the skull but is most common in the temporal bone. 2. Acquired cholesteatoma, whose pathogenesis includes epithelial migration and invasion, implantation invasion, epithelial metaplasia, and hyperproliferation of basal cells. Acquired cholesteatoma can be further divided into two types: primary acquired cholesteatoma, caused by Eustachian tube dysfunction leading to the formation of tympanic membrane retraction pockets, subsequent accumulation of epithelial debris, and ultimately formation of cholesteatoma; and secondary acquired cholesteatoma, where epithelial cells migrate into the middle ear through the edge of a tympanic membrane perforation. Trauma or surgery can also cause squamous epithelial cells to be implanted in the middle ear cavity, forming secondary acquired cholesteatoma. These iatrogenic cholesteatomas are often caused by squamous epithelial cells being brought into and enclosed within the middle ear during tympanoplasty and tympanic membrane catheterization.
The treatment methods for middle ear cholesteatoma include medication and surgery. Antibiotic therapy can only temporarily control the infection and alleviate symptoms but cannot remove the internal cholesteatoma lesion. Therefore, medication is only used as an adjunct and preparation for surgical treatment. There are various surgical procedures for treating cholesteatomatous otitis media, but they can be summarized into the following five types: open cavity tympanomastoidectomy, canal-wall-up tympanoplasty with mastoidectomy, mastoidectomy with preservation of the bony bridge, mastoidectomy with reconstruction of the external auditory canal, and middle ear and mastoid endoscopy surgery. Choosing the correct surgical method can not only completely remove the cholesteatoma and prevent recurrence but also preserve or improve hearing and quality of life.
