Your Audiology Tutorial: Cholesteatoma

What may appear to some as wax in the outer ear canal may well be a cholesteatoma, a growth of squamous epithelium (non-cancerous) in the middle ear space behind the tympanic membrane (eardrum), usually affecting its upper quadrant.  We have seen patients whose ears were examined at internists' offices and the ever popular urgent care centers (sometimes referred to as "the doc in a box") and the issue was missed.  The canal must be cleared before a cholesteatoma can be identified.  

Symptoms are typically some sort of discharge, otalgia (earache), hearing loss, tinnitus, and sometimes dizziness.  If the growth is left untreated it can damage the three bones (malleus, incus, and stapes) attaching the eardrum to the inner ear.  Damage to the semicircular canals/vestibular area for balance may also manifest.  The facial nerve, which passes through this area can also be affected. Imaging studies (MRI or CT)  are used to rule out other possible causes of symptomology. 

Cholesteatomas may occur due to damage to the eardrum (both from patient activity and anatomical malformations), cell metaplasia (possible precursor to carcinoma), and/or heredity.