Cholesteatoma of the ear: causes, symptoms, diagnosis, treatment, consequences

One of the most common causes of severe hearing impairment is the cholesteatoma. It is a neoplasm consisting of particles of a degenerate epithelium. Expanding, it blocks the cavity of the middle ear, causing unpleasant symptoms. When dull and pressing ear pain, dizziness and fetid discharge occur, you should immediately contact an otorhinolaryngologist. Who knows what and what heals, everyone knows for sure. In today's article, we will dwell in more detail on the features of this pathological process.

The essence of the ailment

Cholesteatoma does not belong to the category of oncological diseases. For the first time it was described in the XIX century, but the modern name was recently received. Only after a detailed study of the composition of the tumor, in which there is a lot of cholesterol, scientists introduced the appropriate term in medical practice. After some time, it was possible to determine the main causes of the disease, to choose effective methods of treatment.

Cholesteatoma of the ear is a tumor-like compound of white color, encapsulated. It is formed by stratified layers of keratinized cells. Dimensions vary from a few millimeters to 5-7 cm. The main components are protein compounds, keratin, lipids and cholesterol. The new formation is covered with a matrix - a sheath of connective tissue that fits snugly to the bone, and sometimes grows into it. During this process, the surrounding tissues are destroyed.

Causes of the disease and its pathogenesis

There are two forms of ear cholesteatoma:

1. Innate, or true. The appearance of the disease is due to embryonic fetal development disorders. The likelihood of its occurrence increases if a woman during pregnancy takes ototoxic drugs, undergoes repeated x-ray irradiation. Neoplasm is usually localized in the pyramid of the temporal bone, less often in the lateral parts of the skull and one of the four ventricles of the brain.
2. Acquired. The disease is diagnosed in adulthood. Predisposing to its development factors are chronic inflammatory pathologies of the ear (otitis, eustachiitis), traumatic injuries.

Modern medicine connects the emergence of the acquired form of pathology with one of the two mechanisms.

In the first case, pathogenesis implies impaired patency of the auditory tube against the background of eustachyte. The pressure in the tympanic cavity decreases, and a part of the membrane gradually retracts into it. Here, cholesterol crystals, depleted epithelial cells and keratin begin to accumulate. Thus, the acquired ear chole- theatoma is formed.

In the second case, mechanical damage or chronic otitis lead to tearing of the tympanic membrane. Between the external ear canal and the middle ear an opening is formed. Through it occurs the germination of the flat epithelium into the tympanum. The capsule from the connective tissue limits the foreign matter, forming a cholesteatoma.

Clinical picture

In most cases, the middle ear cholesteatoma does not show itself as a specific symptom. This variant of the development of events does not occur to everyone. Some patients go to the doctor with the following complaints:

• Pain in the ear, characterized by a bursting character;
• Discomfort in the temple or forehead;
• Hearing impairment;
• The presence of secretions from the ear with impurities of pus, unpleasantly smelling;
• Nausea and severe dizziness.

At small sizes, the tumor can not be visually examined. A large formation looks like a white curdled lump that swells through the external auditory canal.

In the case of secondary bacterial infection, the clinical picture is supplemented with symptoms of intoxication. Patients complain of a sharp increase in temperature, rapid fatigue, weakness and loss of appetite. In the region of the affected ear, a throbbing pain is possible.

Possible complications

If you ignore the symptoms of the disease and delay treatment, it can lead to complications. Among them, the most common are the following:

1. Fistula of the labyrinth, accompanied by complete loss of hearing.
2. Paresis of the facial nerve.
3. Thrombosis of sigmoid sinus.
4. Aseptic meningitis.
5. Meningoencephalitis.
6. Coma.
7. Edema of the brain.

Do not be afraid of malignant neoplasm. Elements of the ear's cholesteatoma are not tumorous. They can not uncontrolledly share and spread through the body in a hematogenous way.

The danger of the pathological process is its proximity to the brain and nerve endings. The secret given by the tumor makes these structures vulnerable. Therefore, meningitis, cerebral edema and other ailments develop rapidly, accompanied by pronounced symptoms. In the absence of quality medical care can lead to death.

Methods of diagnosis

If suspected cholesteatoma should be as soon as possible to contact the otorhinolaryngologist. Who knows what this doctor is treating, even small children know. If you go to the reception to the local therapist, he will also give a referral to a specialist for detailed diagnostic.

It begins with an external examination of the auditory canal through an otoscope. With the help of this device it is possible to detect inflammatory processes, to reveal the presence of pathological formations and changes in the structure of the tympanic membrane. The patient is then assigned radiography. The pictures clearly visualize the tumor, if it is present. An experienced doctor can estimate its size and precise localization. However, a more detailed picture provides a computed tomography.

Additional survey methods include:

• Audiometry for testing the severity of a patient's hearing;
• Examination for sound perception through a tuning fork;
• Vestibulometry - analysis of the functions of the vestibular apparatus.

The listed procedures today can be taken at any clinical center of otorhinolaryngology. Based on the results of the complex examination, the doctor confirms or refutes the preliminary diagnosis, makes recommendations for the elimination of the disease. Today, neoplasm can be treated in two ways: conservative and surgical. About them in more detail will be told just below.

Conservative treatment

In the early stages of the disease can be eliminated by conservative methods. Usually, they resort to washing the overdrug space with a solution of boric acid or proteolytic enzymes. Manipulation should be repeated daily for one week.

If the standard procedure does not improve the patient's condition, you must use a special hollow tube with a bend at the end. During the procedure, the doctor enters it through the hole in the tympanic membrane. With timely therapy, the discharge of pus from the ear stops, and the damaged tissue regenerates quickly.

Surgical intervention

When conservative methods do not allow the elimination of pathology, surgical removal of cholesteatoma is recommended. Among other indications for an urgent operation, it can be noted:

• Intracranial complications;
• osteomyelitis;
• Paresis of the facial nerve;
• Labyrinthite;
• Periodically inflamed polyps.

The above list only the most common cases when surgical removal of the ear's cholesteatoma is required. The operation is always assigned on an individual basis, taking into account the clinical picture and overall health of the patient.

The procedure itself consists of several stages. First, the doctor removes the tumor-like formation. In order to rule out the redistribution of the infectious process, he carries out the sanation of the cleared cavity. In some cases, the plastic of the tympanic membrane is additionally assigned to restore its integrity.

Recovery after removal of cholesteatoma of the ear

The consequences of the operation in the form of dizziness or nausea can accompany the patient for 7-10 days. Gradually, such symptoms disappear, additional medication is usually not required. Before discharge, the doctor must remove the stitches from the wound and apply a bandage. It is recommended to change it every few days until full recovery. To accelerate the healing of wounds, physiotherapeutic procedures are sometimes prescribed.

After 4 weeks after discharge, it is necessary to undergo a follow-up examination. On it, the doctor usually checks the patient's hearing. If a repeat operation is required, it can be done only 6 months after the first. Otherwise, complications can not be avoided.

Methods of prevention

Cholesteatoma is not classified as an oncological disease. But this does not mean that its initial symptoms can be ignored, do not seek medical help. Qualitative treatment always avoids the development of complications. Is it possible to prevent the appearance of this pathology?

Prevention of the disease primarily involves timely treatment of all inflammatory processes affecting the ears. This is especially important for pregnant women and children. Cholesteatoma of the ear in a child is a fairly common phenomenon. Unfortunately, its development is often accompanied by local encephalitis and hydrocephalus.

Also, the prevention of an ailment implies the strengthening of immunity. To this end, it is necessary to regularly use vitamin complexes, eat right and lead a healthy lifestyle. Do not forget about the procedures of hardening and feasible sports.