Cholesteatoma is not a tumor, but it is better than a tumor because it has such characteristics!

Author: Ma Furong, Chief Physician, Peking University Third Hospital

Vice President of the Otolaryngology Branch of the Chinese Medical Doctor Association

Reviewer: Wang Ningyu, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Member of the Otorhinolaryngology and Head and Neck Surgery Committee of the Chinese Medical Association

Cholesteatoma is a mass-like mass composed of a mixture of squamous epithelium, keratin and a small amount of cholesterol crystals, surrounded by fibrous connective tissue. It has the characteristics of gradually expanding, eroding surrounding bones and destroying important organs.

Cholesteatoma is a benign lesion, not a tumor, but it is more like a tumor, so it is called a tumor. It is very dangerous.

Cholesteatoma often occurs in the middle ear. How is it formed?

Figure 1 Original copyright image, no permission to reprint

1. How is cholesteatoma formed?

During the embryonic development of the human body, the ectoderm generally develops into skin, which is covered by squamous epithelium. If these epithelia are not fully developed, they will remain in places where they should not be, such as in the middle ear cavity, petrous apex, etc., and congenital cholesteatoma will form. The incidence of congenital cholesteatoma is not high.

The most common type is acquired cholesteatoma. How is acquired cholesteatoma formed?

One theory holds that due to Eustachian tube dysfunction, negative pressure appears in the middle ear cavity, causing the eardrum to collapse, forming an invaginated sac. The squamous epithelium in the sac is constantly metabolized and accumulated. Since it cannot be discharged in time, the squamous epithelium will crawl into the middle ear cavity. The squamous epithelium is constantly falling off, like a snowball, and it not only squeezes and expands, but also secretes enzymes, causing many complications. This is the invaginated sac theory.

There is also a theory that if one had otitis media as a child, it would cause a large perforation of the eardrum, and the surrounding squamous epithelium would crawl into the middle ear cavity through the perforated eardrum, forming a cholesteatoma, which would damage the surrounding bones and some important structures.

These two are the most common theories. There is also the theory that the mucosal metaplasia in the middle ear cavity turns into squamous epithelium, but these have not been conclusively confirmed.

2. What are the symptoms of cholesteatoma?

The ear is a very important organ in the human body, including the outer ear, middle ear and inner ear. The auricle and the ear canal are collectively called the outer ear, which collects and transmits sound. The middle ear is like a transformer, which amplifies the sound and transmits it to the inner ear. The inner ear can not only sense sound, but also is the most important balance system.

Cholesteatoma can cause earache, pus discharge from the ear, and a foul smell; some patients may feel stuffy in the ears; some patients may experience tinnitus, wind-like tinnitus, and high-pitched tinnitus. Cholesteatoma can damage important organs in the ear, such as the ossicles, which can cause hearing loss; facial nerves, which can cause facial paralysis; cochleae, which can cause hearing loss or even hearing loss; semicircular canals, which can cause unsteady walking, dizziness, nausea and vomiting; and brain tissue invasion, which can cause intracranial and extracranial complications such as meningitis and brain abscesses.

Figure 2 Original copyright image, no permission to reprint

Some cholesteatomas occur in the external auditory canal, but they can also damage the middle ear and go directly into the skull, causing some complications.

Therefore, cholesteatoma is a disease that can cause serious consequences and should not be ignored. If you experience tinnitus, stuffy ears, hearing loss, or even dizziness, or ear pain, itching, etc., as long as there is ear discomfort, you should seek medical attention in time, be vigilant, and try to detect cholesteatoma early.

Cholesteatoma is a benign lesion that does not develop very quickly. It has a long silent process, but it slowly destroys the surrounding bones, like a time bomb. The earlier it is discovered, the less damage it will cause.

For example, if the disease is found outside the auditory bones, the auditory bones can be preserved. After the lesion is cleaned and the eardrum is repaired, the hearing will be the same as that of a normal person without being affected at all.

When the ossicles are damaged, they can only be replaced with artificial ones, which are certainly not as good as natural ones and will affect hearing. At this time, the main purpose is to clean up the lesions, eliminate the dangers, and prevent intracranial and extracranial complications, at least to prevent intracranial infections, facial paralysis, vertigo and other intracranial and extracranial complications.

When cholesteatoma invades the brain and causes intracranial infection, it is no longer a matter of preserving hearing, but of saving lives.

Therefore, once cholesteatoma is discovered, surgery should be performed as soon as possible to reduce damage to surrounding organs and avoid serious consequences.

3. How to prevent cholesteatoma?

To prevent cholesteatoma, you need to prevent upper respiratory tract infections. Children who often suffer from upper respiratory tract infections and repeated colds should pay attention to whether the tympanic membrane is retracted. If so, they should be observed regularly to prevent it from developing into cholesteatoma.

Whether it is inflammation or allergy, it will cause swelling, narrowing or closure of the Eustachian tube, and the middle ear cavity will easily form negative pressure or even fluid accumulation, forming a sunken sac. For example, if you have rhinitis, sinusitis, pharyngitis, or tonsillitis, you should seek medical attention in time to treat the inflammation and control the allergy.