"Nop, I cannot locate the eardrum in the right ear", I thought. "Jon, let me show you what I see in your right ear if you are fine to take a look at it", I continued, and with his consent, I put the video-otoscope in his right ear canal.
"Is this ear wax buildup?" he asked. "I am afraid it is not ear wax, it might be what we call a Cholesteatoma, a benign accumulation of skin in the middle ear that eventually pushes the eardrum out", I responded cautiously.
Jon is one of many patients I attend every week, who come to the clinic to find out why their hearing is impaired, often on one side. The first suspect is usually the ear wax buildup, but not always.
What is a Cholesteatoma?
Cholesteatoma is a cystic lesion formed from keratinizing stratified squamous. Keratosis obturates (KO) is the buildup of keratin in the ear canal. Keratin is a protein released by skin cells that form the hair, nails, and protective barrier on the skin. This process may happen in the middle ear, but it can also be in the ear canal. The growth of the cyst is very subtle and slow and the patient may not notice it until the cyst becomes big enough to push the structure of the eardrum resulting in hearing impairment.
What can be mistaken for cholesteatoma?
Besides excessive ear wax buildup, several otological conditions can mimic the appearance of a cholesteatoma such as an osteoma, Osteoma is a growth of the bone of the ear canal forming a sessile lump. Diagnosis can be confirmed by their solid nature on palpation.
How do you rule out a Cholesteatoma?
In addition to the visual examination, a hearing test including a tympanometry test would be a good start to confirm the presence of the Cholestitoma. The ENT specialist may also do the following tests: Computed tomography (CT) scan to see if the condition damages the ossicles (ear bones).
What are the symptoms of Cholesteathoma if not noticed?
An unattended Cholesttheatoma may have a mix of the following symptoms at advanced stages:
A smelly discharge that may look like pus flowing from your ear or your child’s ear.
Pressure or a feeling of fullness in your ear.
Dizziness.
Recurrent ear infections
Does cholestithoma happen only to adults?
No, Cholesteatoma is not age or gender-specific, meaning kids and young children who experienced a middle ear infection may develop Cholesteatoma.
How can a Cholesteatoma be treated?
Treatments depend on the cause and symptoms, but surgeries like mastoidectomy and tympanoplasty are the only ways to remove a cholesteatoma.
Does a Cholesteatoma come back?
It may, that's why patients with a history of Cholesteatoma need to have regular hearing tests and checkups to monitor the status of their middle ear.
What happened to Jon?
All under control, Jon was referred to his GP with a request for an urgent visit to an ENT specialist. He was kind enough to leave us a review on our Trustpilot (see below).
What else could feel like an ear wax build-up?
If you are having a problem with hearing muffled on one side right after a cold, sinus infection, severe cough, or a soar throat, the problem could be related to your Eustachian tube. Please see our full article on ETD here. The article discusses in detail a case of Eustachian tube dysfunction and how to clean it with simple techniques.
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