There are many things that can impact our hearing-health. Most of these we know – noise-exposure, for instance, or a hereditary condition, wax build-up and even ear infection. We seem to have a general knowledge of the things that are classed as bad for our hearing and cause hearing loss, but there are some conditions, which are still in the shadows a little bit, and only show up on our radar when it happens to us or someone we know.
One of these conditions is Cholesteatoma. But what is a Cholesteatoma? Is it something you should be aware of? Could Cholesteatoma cause you to experience hearing loss?
A Cholesteatoma is an abnormal growth of skin cells behind the eardrum. This collection of skin cells can grow and shed, which may cause issues for your hearing health. A Cholesteatoma can be present from birth, developing in-utero, but in most cases develops over time, tending to be the result of recurrent middle ear concerns.
Middle ear concerns tend to be very common for children. With their middle ear structures still developing, they can be more prone to troubles with the middle ear. Adults also experience middle ear concerns, however, the rate of Cholesteatoma is much higher in children, due to these key differences in anatomy.
People born with abnormalities to their skull and facial structure, such as cleft palate for instance, also tend to be more at risk of Cholesteatoma, because of the differences in anatomy.
Abnormal growth is something you need to take action on. A Cholesteatoma can cause real issues for your general and hearing health, with one of the key worries being hearing loss. If you leave a Cholesteatoma untreated, you may continue to struggle with a recurrent ear infection which can cause significant harm.
A chronic ear infection can damage our middle ear structures. It can change the way the eardrum operates and moves to sound, causing conductive hearing loss. The sound cannot be conducted further through the middle ear system and to the inner ear properly and we can suffer from a hearing loss as a result.
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A Cholesteatoma can erode bone, including the bones which move our eardrum – the stapes. These bones are also imperative in the middle ear system to conduct sound, and in not working, can also present as a hearing loss.
This erosion may cause further infection and can spread to something known as the mastoid process, the bone behind our ear, and even the brain. In some cases, this can lead to meningitis, a brain abscess, issues with our facial nerve, balance concerns, and in a worst-case scenario, death.
A common middle ear concern for children and adults alike is Eustachian Tube Dysfunction. Eustachian Tube dysfunction can, in itself, cause hearing difficulties and hearing loss. The Eustachian Tube is a tube that runs from behind the nose and throat to the middle ear space. Sometimes this tube doesn’t open and shut as effectively as it should, often because someone is unwell with respiratory issues, seasonal allergies or as mentioned above, due to anatomical reasons.
Eustachian Tube dysfunction causes a pressure imbalance and poor ventilation in the middle ear. As a result, the eardrum tends to retract and gets pulled back in on itself. This creates a pocket, where skin cells, wax and debris tend to collect. The skin cells multiply and shed, growing over time. This is what we call a Cholesteatoma.
The same can happen with repeated ear infections, where someone might suffer from ear infections which cause a perforated eardrum. Skin from the ear canal can grow into the perforation, and into the middle ear space, also leading to a Cholesteatoma.
Given there are significant consequences associated with Cholesteatoma, it is important to manage it as soon as possible. Sometimes a Cholesteatoma has been preceded by an ear infection and the person is under the care of their GP for treatment.
It is important to see your Audiologist as well. In this, a full diagnostic hearing assessment can be conducted. Otoscopy, the visualisation of the ear canal and eardrum is thought to be one of the best initial ways to determine if someone has a Cholesteatoma – in its primary stages before the Cholesteatoma starts to involve the middle ear structures and create a tangible hearing loss.
As well as Otoscopy, it is essential to have an appointment with an Audiologist to establish the function of the outer, middle and inner ear and to determine if there is any hearing loss. This is a good opportunity to gain a baseline of the person’s hearing levels and/or hearing loss.
In the majority of cases, there is evidence of a conductive hearing loss, however, in some, where the Cholesteatoma has begun to progress to the inner ear, there can also be evidence of a sensorineural hearing loss – a hearing loss which is of a more permanent nature. Often, but not always, people with a Cholesteatoma can present with a full feeling in the offending ear, active discharge from the ear, and a hearing loss.
In most cases, a Cholesteatoma is managed by surgery. In efforts to remove it, Ear Nose and Throat (ENT) specialists and surgeons do attempt to preserve hearing and try to prevent a significant hearing loss in the process. The extent of the surgery is dependent on how much the Cholesteatoma has progressed, however.
In most cases, medical imaging is needed to determine the progression of the growth – to check if the Cholesteatoma is focused on the middle ear space, or has progressed to bone, or further potentially.
The main goal is to create an infection-free, dry ear. Because this is the focus, hearing loss can be an inevitability. The surgeries involved could include repairing and reconstructing the eardrum, having a mastoidectomy, where the bone behind the ear is removed, and even reconstructing the stapes. In performing this kind of surgery, there is usually an impact on the person’s hearing, with a hearing loss a very real outcome.
For some people where surgery is not an option due to ill health or being elderly, and surgery poses more significant risks, some ENT specialists do more conservatively manage a Cholesteatoma, routinely removing the build-up of skin to prevent progression. This needs to be done regularly to prevent the serious health concerns listed above – again, hearing loss is an outcome for these patients.
Because the very procedures used to manage a Cholesteatoma do often see a hearing loss, it is important to consider options to assist with the hearing loss once the ENT specialist has secured a dry and infection-free ear. In some cases, for children and adults alike, the change in hearing can be quite marked and cause troubles for communication – at school, at work or socialising with friends and family.
This can have significant impacts on general well-being as well. Many people who do struggle with their hearing following surgery can benefit from hearing devices to assist with their hearing loss. It is important to select a hearing device with your Audiologist which considers the health of the ear now and moving forward.
In some cases, the client and Audiologist can select a hearing device which allows the ear to breathe and ensure ventilation, or there could be a real need to consider bone conduction aids, which are not like a traditional hearing aid, rather implanted surgically. They make use of a different route to air conduction, which sends sound through the ear canal and middle ear system. As mentioned above, with Cholesteatoma this traditional route has been compromised by infection, the cholesteatoma and possibly reparatory surgery.
A favourable outcome for those with Cholesteatoma relies on early detection and a thorough approach to assessment. It also relies on management with an ENT specialist – whether this is through surgical means or a more conservative approach.
It’s important to ensure hearing-health and make an appointment with an Audiologist if having repeated ear infections or experiencing concerns with hearing or discharge from the ears.
In this, the significant health concerns associated with Cholesteatoma could be avoided, the extent of a hearing loss could be managed, and if in managing the Cholesteatoma, hearing loss presents as a key concern, this could also be managed with the help of an Audiologist.
There is also the need to continue to monitor the person and review the person’s hearing loss – checking for recurrence. Ultimately hearing loss does come hand-in-hand with a Cholesteatoma, but so do other health concerns. In managing your hearing loss with your Audiologist and ENT specialist, you are managing a number of other potential health concerns and ensuring your hearing-health and general health long-term.
If you have any questions about Cholesteatoma and its treatments, feel free to give us a call or get in touch with your local Attune Hearing clinic to schedule an appointment. We’d be happy to answer all of your questions!