One of the most common causes of severe hearing loss is cholesteatoma. This is a neoplasm consisting of particles of degenerate epithelium. Growing, it blocks the middle ear cavity, causing unpleasant symptoms. With the appearance of dull and pressing ear pain, dizziness and fetid discharge, you should immediately contact an otorhinolaryngologist. Who it is and what it treats, everyone knows for sure. In today's article, we will dwell in more detail on the features of the mentioned pathological process.
Essence of disease
Cholesteatoma does not belong to the category of oncological diseases. It was first described in the 19th century, but received its modern name recently. Only after a detailed study of the composition of the tumor, in which there is a lot of cholesterol, did scientists introduce the corresponding term into medical practice. After some time, it was possible to determine the main causes of the disease, to find effective methods of treatment.
Cholesteatoma of the ear is a white tumor-like compound enclosed in a capsule. It is formed by layers of keratinized cells overlapping each other. Dimensionsvary from a few millimeters to 5-7 cm. The main components are protein compounds, keratin, lipoids and cholesterol. The neoplasm is covered with a matrix - a shell of connective tissue that fits snugly against the bone, and sometimes grows into it. During this process, the surrounding tissue is destroyed.
Causes of the disease and its pathogenesis
There are two forms of ear cholesteatoma:
- Congenital, or true. The appearance of the disease is due to embryonic developmental disorders of the fetus. The likelihood of its occurrence increases if a woman takes ototoxic drugs during pregnancy, is exposed to repeated X-ray exposure. The neoplasm is usually localized in the pyramid of the temporal bone, less often in the lateral sections of the skull and one of the four ventricles of the brain.
- Purchased. The disease is diagnosed in adulthood. Factors predisposing to its development are chronic inflammatory pathologies of the ear (otitis media, eustachitis), traumatic injuries.
Modern medicine associates the occurrence of an acquired form of pathology with one of two mechanisms.
In the first case, the pathogenesis implies a violation of the patency of the auditory tube against the background of eustachitis. The pressure in the tympanic cavity decreases, and part of the membrane is gradually drawn into it. Cholesterol crystals, desquamated epithelial cells and keratin begin to accumulate here. Thus, acquired ear cholesteatoma is formed.
In the second case, mechanical damage or chronic otitis media lead to teareardrum. An opening forms between the external auditory meatus and the middle ear. Through it, the squamous epithelium grows into the tympanic cavity. A connective tissue capsule confines foreign matter, forming a cholesteatoma.
Clinical picture
In most cases, middle ear cholesteatoma does not manifest itself with specific symptoms. This scenario is not for 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 loss;
- presence of discharge from the ear with impurities of pus, smelling unpleasant;
- nausea and severe dizziness.
With a small size, the tumor cannot be visually examined. A large mass looks like a white curdled lump bulging through the external auditory canal.
In the case of a secondary bacterial infection, the clinical picture is supplemented by symptoms of intoxication. Patients complain of a sharp increase in temperature, fatigue, weakness and loss of appetite. Throbbing pain is possible in the area of the affected ear.
Probable Complications
If you ignore the symptoms of the disease and delay treatment, it can lead to the development of complications. Among them, the following are recognized as the most common:
- Fistula of the labyrinth, accompanied by completehearing loss.
- Paresis of the facial nerve.
- Sigmoid sinus thrombosis.
- Aseptic meningitis.
- Meningoencephalitis.
- Coma.
- Cerebral edema.
You should not be afraid of malignancy of a neoplasm. Elements of cholesteatoma of the ear are not tumor. They cannot uncontrollably divide and spread throughout the body through the hematogenous route.
The danger of the pathological process lies in its proximity to the brain and nerve endings. The secret secreted 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, they can lead to death.
Diagnostic Methods
If you suspect cholesteatoma, you should contact an otorhinolaryngologist as soon as possible. Who it is and what this doctor treats, even small children know. If you go to an appointment with a local therapist, he will also give a referral to a narrow specialist for a detailed diagnosis.
It begins with an external examination of the ear canal through an otoscope. Using this device, you can detect inflammatory processes, identify the presence of pathological formations and changes in the structure of the eardrum. The patient is then given an x-ray. The images clearly show the tumor, if present. An experienced doctor can estimate its size and exact localization. However, computed tomography provides a more detailed picture.
To the number of additional methodssurveys include:
- audiometry to check the patient's hearing acuity;
- examination for sound perception through a tuning fork;
- vestibulometry - analysis of the functions of the vestibular apparatus.
The listed procedures today can be done in any clinical center of otorhinolaryngology. Based on the results of a comprehensive examination, the doctor confirms or refutes the preliminary diagnosis, gives recommendations for eliminating the disease. Today, the treatment of neoplasms is possible in two ways: conservative and surgical. They will be discussed in more detail below.
Conservative treatment
In the early stages, the disease can be eliminated by conservative methods. Usually they resort to washing the epitympanic space with a solution of boric acid or proteolytic enzymes. Manipulations must be repeated daily for one week.
If the standard procedure does not improve the patient's condition, you have to use a special cavity tube with a bend at the end. During the procedure, the doctor inserts it through an opening in the eardrum. With timely therapy, the discharge of pus from the ear stops, and damaged tissues quickly regenerate.
Surgery
When conservative methods fail to eliminate the pathology, surgical removal of cholesteatoma is recommended. Among other indications forurgent operation can be noted:
- intracranial complications;
- osteomyelitis;
- paresis of the facial nerve;
- maze;
- periodically inflamed polyps.
The above lists only the most common cases when surgical removal of ear cholesteatoma is required. The operation is always prescribed on an individual basis, taking into account the clinical picture and the general he alth of the patient.
The procedure itself consists of several stages. First, the doctor removes the tumor. To exclude the re-spread of the infectious process, he sanitizes the cleaned cavity. In some cases, tympanic membrane plastic surgery is additionally prescribed to restore its integrity.
Recovery after ear cholesteatoma removal
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 medical care 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 complete recovery. Physical therapy is sometimes prescribed to speed up wound healing.
A follow-up examination is required 4 weeks after discharge. On it, the doctor usually checks the patient's hearing. If a second operation is required, it can be performed only 6 months after the first one. Otherwise, it will not be possible to avoid the development of complications.
Prevention Methods
Cholesteatoma does not belong to the category of oncological ailments. But this does not mean at all that its initial symptoms can be ignored, not to seek medical help. High-quality treatment always avoids the development of complications. Can this pathology be prevented?
Prevention of the disease primarily involves the 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 the disease involves strengthening the immune system. To this end, it is necessary to regularly consume vitamin complexes, eat right and lead a he althy lifestyle. Do not forget about hardening procedures and feasible sports.
