Ear cholesteatoma: definition, signs, treatment

Cholesteatoma of the ear is the formation of the middle ear, like a tumor, but a tumor is not. It mainly consists of sticky skin cells and cholesterol crystals. All contents of the cholesteatomais surrounded by a capsule.

Manifestations of pathology rather unpleasant and worsen the patient’s quality of life is, first and foremost, hearing loss, ear pain, and putrid discharge from it.

Cholesteatoma to diagnose and easy to cure it radically possible only through surgical intervention. Sometimes a certain therapeutic effect is achieved when washing nabereshnoy cavity, but a complete cure does not occur.

General data

Ear cholesteatoma in comparison with other pathologies of the ENT sphere is less common – it is detected in the 1.5-4% of all cases of identified pathology of the outer, middle and inner ear.

The disease is diagnosed in patients from infancy to old age. This files most often diagnosed in the age group of 10 to 25 years, but diagnosis may be late due to the asymptomatic course of pathology: small children cannot complain of hearing loss, and age older consider it the norm, therefore also not specifically appeal for help to the doctor.

Males and females are equally likely to get sick. The disease occurs with approximately equal frequency in most regions.

Pathology may be either congenital or acquired. In the first case it is called cholesteatomas true and the second false.

Congenital cholesteatoma has a specific view:

• the correct rounded shape;
• a smooth shiny surface, which is due to the peculiarities of the structure of the capsule.

This kind of cholesteatoma is similar to the pearl, it received another name – “pearly tumor”.

Reasons

True cholesteatoma of the ear is formed due to the embryonic disorders. Classically they develop due to the influence of harmful factors on an organism of future mother and hence the fetus.

Such factors are:

• age;
• physical;
• chemical;
• infectious;
• environmental;
• bad habits;
• emotional;
• inflammatory;
• hormonal.

Failure of embryonic development, which can lead to the development of ear cholesteatoma, occurs more frequently if the woman is considered to be age pervorodyaschih – that is, becomes pregnant and gives birth for the first time after the age of 35 years.

Physical factors one of the most influential and common factors against which fetal disorders with the subsequent formation of a cholesteatoma of the ear occur more frequently.

They can be divided into groups:

• mechanical;
• heat;
• radioactive.

Mechanical negative factor, which is able to cause the appearance of entities by the type of cholesteatoma, are injuries to the abdomen of a pregnant woman – at blows, falling on a stomach or other types of mechanical action, the risk of violations of embryogenesis increases significantly.

A similar outcome is observed in the influence on the organism of future mother is too high or too low temperatures. On the one hand, the fetus is protected from the action of thermal factor fetal bladder and uterine wall, with another – the thermal factor, adversely affects the processes in the organs and tissues of the pregnant woman, which leads to violation of fetal development of the unborn child.

Radiation exposure is one of the most powerful factors of pathological effects on fetal development.

This files most often occurs when a pregnant contact with radioactive substances due to their professional activities, often in the early lines, when a woman may not know she is pregnant. Radioactive effects in the force assigned to radiotherapy noted rarely before nominating a woman examine and ascertain the pregnancy, and then adjust the treatment plan.

Chemicals is one of the most frequently observed factors influencing the development of the fetus, which he formed congenital abnormalities. Entering the mother’s bloodstream, and then into the bloodstream of the fetus, they affect tissue processes that then results in a teratogenic effect (impaired fetal development).

Aggressive effects on the body of the fetus identified by:

• chemicals used in industry or in agriculture;
• a number of medical drugs;
• tools used in everyday life.

A separate group of agents-provocateurs – the toxins that have formed in the mother’s body when disintegration of its own tissues or bodies of infectious pathogens. This process can be observed not only in infectious diseases but also a number of other pathologies.

Teratogenic production are such substances as:

and several others.

Of compounds used in agriculture, especially pronounced teratogenic effect observed with nitrate and nitrite.

Any medication, once in the bloodstream of the mother, then the fetus can cause failure of fetal development – in this case, the disruption of the formation of the middle ear and, as a consequence, the formation of cholesteatoma of the ear. This effect is most pronounced in the following groups of drugs:

and some others.

Household remedies possess no less teratogenic than the compound used in the manufacturing or agriculture. A different means for cleaning, repair, maintenance (paints, varnishes, solvents), and others.

Infectious factor as one of the most common teratogenic factors.

Violation of fetal development are most often observed in such infectious diseases pregnant:

• rubella – a viral disease that manifestirutaya characteristic visibly in the form of red spots;
• measles – an infectious disease manifested by spotty rash skin. Is considered a children’s disease, but also affects adults;
• cytomegalovirus – a viral disease, which causes DNA-containing virus of the family of herpes viruses;
• influenza – an acute viral infection of the respiratory tract, triggered by a number of influenza virus strains;
• toxoplasmosis is an infectious pathology caused by the parasite Toxoplasma;
• mycoplasmosis is an infectious disease triggered by a Mycoplasma

a number of other

Poor environmental conditions increases the risks of intrauterine development disorders in the fetus – in this case, the occurrence of cholesteatoma of the ear.

Factors with particularly negative effects are:

• the use of water, which increased the content of chemical (organic and inorganic) compounds;
• increased radiation background;
• the contamination of inhaled air.

Bad habits pregnant is one of the greatest threats to the normal development of the fetus. Smoking, drinking alcoholic beverages and drugs equally increase the risk of cholesteatoma of the ear, and with it more serious violations, against which this pathology may be diagnosed late.

Unfavorable emotional background of the mother is sometimes enough to provoke failures in utero development of the fetus – including the formation of a cholesteatoma of the ear.

Also the body of a pregnant with a subsequent impact on the fruit can act professional negative factors are:

• work in a dusty or smoke-filled room;
• long working hours;
• effects on the body of the mother vibration (observed at work for the machine)

and others.

The endocrine disruptions of any nature on the part of the body of a pregnant can lead to failure of the fetal development and the formation of cholesteatoma of the ear. Moreover, the role plays as a lack of hormone production, and excessive synthesis.

The reasons that cause the formation of acquired cholesteatoma of the ear, less than the etiological factors of education of the same disease, but congenital.

Most often the factors that trigger the formation of acquired cholesteatoma are:

• otitis – inflammation of the various divisions of the ear:
• injury – shredded, chopped, bite, puncture, gunshot, shattered.

Ear infections are the most common cause of acquired cholesteatoma of the ear is 90% of cases it occurs on the background of chronic suppurative otitis media.

The development of the disease

Congenital cholesteatoma of the ear is often formed in the pyramid of the temporal bone, although it can also occur in:

• other bones of the skull;
• the tank side of the brain;
• the ventricles of the brain.

Acquired cholesteatoma of the ear is maximum in most cases is revealed in the pyramid of the temporal bone.

It is believed that about cholesteatoma of the ear is formed in two ways. In the first case, the squamous epithelium of the external auditory canal in the literal sense grows into the middle ear cavity through a ruptured eardrum. In the second case, cholesteatoma of the ear appears when impaired patency of the auditory tube, which often occurs because the Eustachian (inflammation of the mucous lining of the Eustachian tube). As in the tympanic cavity pressure is reduced, there is a retraction in a small fragment of the tympanic membrane. When a retraction becomes pronounced enough, this fragment start to settle keratin and peeled off epithelium, which leads to the formation of cholesteatoma of the ear.

Education has a layered structure. The contents of the cholesteatoma ‘ wrapped up a capsule of connective tissue. Under the capsule there is a layer of cells of keratinizing squamous epithelium that slapelis with each other.

Middle ear cholesteatoma layer is superimposed on each plate epithelium, which is peeled, placed in between the cholesterol crystals. The Central part of the ear cholesteatoma is a whitish detritus is a substance similar to a homogeneous mush. It has a putrid smell which can be felt when it is discharge from the ear.

Cholesteatoma of the ear can be isolated or manifest in the form of clusters of small nodules (10-20 to a large number). They can reach 3 mm in diameter and have a dense consistency.

Cholesteatoma of the ear has a specific feature – it highlights the active chemicals that eat away bone tissue of the middle ear, which are next to education. As a result, the bony structures of the formed cavity. Also, these substances have a definite toxic effect on the nerve fibers that comprise the receptor apparatus of the inner ear. Exactly-and this nuance, and not because of the physical presence of cholesteatoma in the ear develop a disorder of perception of sounds and jet labyrinthitis (inflammation of labyrinth as a response to exposure to toxic chemicals).

Symptoms

Very often the period of formation of the ear cholesteatoma may be asymptomatic. The duration of this period is individual, sometimes it may take many months.

Symptoms appear when the progression of disease – increased cholesteatoma of the ear. Often you experience the following symptoms:

Characteristics of pain:

• localization deep in the ear;
• distribution can radiate to (give) in the area of the temporal bone;
• in character – dull, pressing, aching, or shooting;
• intensity – first unspoken, then at least increase the cholesteatoma growing;
• the appearance – appear immediately, but after some time, with the progression of the disease.

Bloating increasing cholesteatoma increases.

Dizziness can occur with the development of labyrinthitis.

Characteristics of the discharge from the ear:

• the number – scarce;
• by the nature of the liquid;
• color yellowish-brown;
• smell have unpleasant putrefactive smell;
• the impurities can include small lumps of white.

Hearing loss, which is observed in cholesteatoma ear can be of different origin. It can occur due to the fact that cholesteatoma is pressing on the auditory ossicles and their mobility deteriorates. Also hearing loss in cholesteatoma ear develops due to disorders of listening, as toxic substances emitted by cholesteatomas, impact negatively on the receptors of the labyrinth.

Diagnosis

The diagnosis of cholesteatoma to put only on the basis of complaints of patient is difficult, additional methods of examination. The disease involved not only the hearing – because of the violation of sound reproduction in the diagnostic process may be involved neurologists and neurosurgeons.

Instrumental methods of research that are informative for the diagnosis of the described disease is:

• skull x-ray – cholesteatoma ear often can be detected on a conventional x-ray image of the skull. Also apply a projection image according to the Mayer, Schüller, or Stenvers – they are education is defined as a homogeneous shade of average intensity, which is located in round pathological cavity with smooth edges;
• computed tomography of the skull (CT scan) – computer sections will more accurately assess the education;
• multislice computed tomography of the skull (CT) – its capabilities are the same as the capabilities of CT;
• otoscopy – using a mirror examine the ear, the outer ear canal. In the case of cholesteatoma of the ear can be detected by the marginal perforation of the eardrum. Can also be detected by the destruction of the bone part of the ear canal – it develops during the growth of cholesteatoma;
• sensing middle ear cavity and diagnostic lavage conduct them in the presence of a perforation of the tympanic membrane. For sensing is used bellied probe – with its destructive process, caused by the growth of cholesteatoma detected by the roughness of the bone. Also an indication that formed a cholesteatoma of the ear, is the following: when flushing the middle ear to the fluid found washed peculiar inclusions and flakes of agglomerated cells of the epidermis.

With auditory and vestibular disorders conducted a study of hearing and vestibular apparatus. For this purpose, such research methods as:

• audiometry – assessment of hearing acuity using spoken language and sounds reproduced by the diagnostic instrument;
• a examination with a tuning fork – a vibrating tuning fork is mounted on mastoid process and determine the perception of sounds by ear;
• determination of patency of the auditory tube;
• electrocochleography – recording and measurement of electrical potentials of the cochlea and the auditory nerve;
• acoustic impedancometry. Consists of tympanometry, during which to assess the mobility of the ossicles and of the eardrum, and acoustic reflexometry, during which register the decrease of the in-the-ear muscles in response to sound stimulation;
• otoacoustic emission and hardware assessment of the ability of the cochlea to generate an acoustical echo in response to sound signals;
• vestibulometry – evaluation of the vestibular apparatus after holding of the vestibular tests (paltsenosovaja, rotational, and others);
• electronystagmography – check the involuntary movements of the eyeballs;
• stabilography – analysis of the human resistance in the standing position;
• indirect otlichaetsya – detection of nystagmus (“swimming” movements of the eyeball) in response to irritation of the skin of the external auditory canal.

Differential diagnosis of

Differential diagnosis of ear cholesteatoma is often carried out with such diseases and pathological conditions, such as:

• foreign body of the ear;
• cochlear neuritis – non-infectious lesion of the auditory nerve, which develops sensorineural hearing loss;
• cerumen impaction;
• pomocna tumor – a benign ear tumor that develops from cells of the nerve fibers;
• adhesive otitis media – inflammation of middle ear, accompanied by the formation of connective tissue bands, and adhesions;
• specific granulomas in tuberculosis and syphilis.

Complications

The complications that most often accompany cholesteatoma ear is:

• facial nerve paresis – a violation of his activities;
• fistula of the labyrinth – a pathological course in its tissues;
• thrombosis of the sigmoid sinus – blockage of a blood clot is a natural splitting of the Dura mater;
• aseptic meningitis – inflammation of the meninges, which in this case develops due to the material content cholesteatoma;
• meningoencephalitis – inflammation of the meninges and brain substance, which develops on the same principle as meningitis;
• brain swelling – it can cause meningitis and meningoencephalitis induced cholesteatomas ear.

The decay cholesteatoma and Association of an infectious agent can develop:

• suppurative labyrinthitis;
• purulent meningitis;
• okolonosovyh abscess – abscess okolonosovykh limited space;
• extradurally abscess – an abscess formed in the space beneath the dural sheath;
• abscess brain abscess in its tissues;
• otogenny sepsis – spread of infection through the blood from the ear throughout the body with the possible formation in other organs and tissues of secondary infectious foci.

Treatment of ear cholesteatoma

Radically to save the patient from ear cholesteatoma can only surgically. With small formations of the ear is rinsed with solutions of proteolytic enzyme, boric acid and isotonic solution.

The type of surgery depends on the prevalence and size of the cholesteatoma. Held:

• sanifying surgery on a middle ear;
• mastoidotomy – opening of the mastoid process of the temporal bone;
• labyrinthectomy – opening of the maze;
• translabyrinthine (through the maze) the dissection of the temporal bone pyramid

and some others.

Prevention

The risk of congenital cholesteatoma of the ear can be reduced if to provide normal conditions of pregnancy, thus preventing the development of congenital abnormalities of the fetus.

Measures for the prevention of acquired cholesteatoma of the ear in the first place are:

• prevention of otitis, and if they’ve evolved their timely detection and treatment;
• warning of injury to structures of the ear, in the presence of injuries – proper relief of their consequences.

Forecast

The prognosis of cholesteatoma ear generally favorable. Surgical excision of the mass is the only method by which the patient may be significantly to get rid of this disease.