CHOLESTEATOMA

What is CHOLESTEATOMA? p Named by Johannes Mueller in 1838 p Ingrowth of the skin of the external ear to the middle ear extending to the mastoid region p Benign slow growing cyst tumor of the middle ear and mastoid region p Due to chronic otitis media Pathophysiology p The status of cholesteatomas as tumors is currently unresolved. There is some evidence to support the hypothesis that cholesteatomas are low-grade tumors.However, recent studies have failed to show consistent DNA instability in cholesteatomas. What are the signs and symptoms of cholesteatoma? p Deafness p Offensive but scanty discharges p Pain due to perforation of the tympanic membrane p The patient may have a recurrent ear discharge. Granulation tissue and a discharge (through a marginal perforation of the ear drum) may be seen on examination. A cholesteatoma cyst consists of desquamating (peeling) layers of scaly or keratinised (horny) layers of epithelium, which may also contain cholesterol crystals. Often the debris is infected with Pseudomonas aeruginosa or other bacteria or organisms. p If untreated, a cholesteatoma can eat into the three small bones located in the middle ear (the malleus, incus and stapes, collectively called ossicles), which can result in nerve deterioration, deafness, imbalance and vertigo. It can also affect and erode, through the enzymes it produces, the thin bone structure that isolates the top of the ear from the brain, as well as lay the covering of the brain open to infection with serious complications (rarely even death due to causing a brain abscess and septicemia). PREVENTIVE MANAGEMENT 1.Tympanostomy tube for early retraction pockets.

Tympanostomy tube-(also known as a grommet or ear tube) is a small tube inserted into the eardrum in order to keep the middle ear aerated for a prolonged period of time, and to prevent the accumulation ofmucus in the middle ear.

2. Surgical exploration for retraction persistence.

CHOLESTEATOMA MANAGEMENT p Treated surgically with primary goal of total eradication of cholesteatoma to obtain a safe and dry ear. p Patients with unacceptable risk of anesthesia need local care. SURGICAL MANAGEMENT p Canal-wall-down Procedures (CWD)-Classic CWD operation is the modified radical mastoidectomy in which middle ear space is preserved. Radical mastoidectomy is a CWD operation in which: middle ear space is eliminated and Eustachian tube is plugged. Meatoplasty should be large enough to allow good aeration of mastoid cavity and permit easy visualization to facilitate postoperative care and self-cleaning.

p Canal-wall-up Procedures (CWU)- CWU procedures developed to avoid problems and maintenance necessary with CWD procedures. CWU consists of preservation of posterior bony external auditory canal wall during simple with or without a posterior mastoidectomytympanotom.

p Transcranial Anterior Atticotomy- Indicated for limited cholesteatoma involving middle air, ossicular chain and epitympanum.

p Bondy Modified Radical Procedure- Useful for attic and mastoid cholesteatoma that does not involve middle ear space and lateral to ossicles.

COMPLICATIONS: 1. Brain abscess- is a collection of immune cells, pus, and other material in the brain, usually from a bacterial or fungal infection. 2. Meningitis- inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. 3. Facial paralysis- common problem that involves the paralysis of any structures innervated by the facial nerve 4. Damage to the inner ear FOREIGN BODIES p can insects, seeds, impacted cerumen p irrigation with warm water or mineral oil p suctioning p instrumentation with the use of curette, biomicroscopic probe.

Prepared by: Ilagan, Katherine c. Bsn iii-3