Therapy
Since the cholesteatoma can lead to the above mentioned severe complications with brain involvement (e.g. meningitis), surgical treatment is necessary. Initially, conservative treatment with antibiotic ear drops (e.g. ciprofloxacin), which are effective against Pseudomonas aeruginosa, the frequent pathogen responsible for the inflammation, is carried out as preparation for surgery. The goals of the surgical treatment are the complete removal of the cholesteatoma, the healing of the bone, the prevention of otogenic (ear-related) complications, the restoration of a functional ossicular chain and the closure of the eardrum defect to close the tympanic cavity in the direction of the external auditory canal.
There are both closed and open surgical techniques. In the open technique, a bone cavity is created that includes the tympanic cavity, the mastoid process cavity and the mastoid cells affected by the inflammation. The cholesteatoma is cleared out, i.e. the horny skin cells are removed and a wide connection to the external auditory canal is also created.
The closed technique involves a so-called mastoidectomy, i.e. the mastoid process, whose cells are aerated and lined with mucous membrane, is completely cleared out so that only its bony walls remain. If the ossicles are also affected by the pearl tumour, a tympanoplasty, the reconstruction of the sound conducting apparatus, may be necessary. This procedure is performed after the removal of the cholesteatoma.
A distinction is made between the five basic techniques according to Wullstein of tympanoplasty (reconstruction of the ossicular chain): Hearing improvement can be achieved by this operation if the auditory trumpet (tube) is continuous and the inner ear is functional. – Type I – Myringoplasty (eardrum plastic)If there is a defect in the eardrum and an intact, vibrating ossicular chain, the eardrum defect is covered/closed and a connection with the ossicles is established. – Type II – OssikuloplastyIf the ossicular chain is defective, missing parts are replaced or a bridging of the missing parts is performed.
- Type IIIIf the transmission chain is defective and no longer functional, the operation ensures direct sound transmission from the eardrum or an inserted graft to the inner ear. – Type IVDThe sound pressure transmission takes place without the ossicular chain. – Type V window surgery: This method involves connecting the eardrum and stapes.
Complications
Due to the destruction of the bones, it is possible that the ossicles are also destroyed and that the sound conduction and sound amplification function of the middle ear is considerably reduced:Hearing loss may develop. The attack/inflammation of the bony mastoid process (mastoiditis) can lead to the formation of a duct to the arcade system (organ of balance), which can lead to attacks of rotary vertigo (dizziness). The inflammation can penetrate into the inner ear and facial canal or even into the cranial cavity (meninigitis).
