American Medical Association Family Medical Guide - American Medical Association [721]
If a child has recurring middle ear infections, his or her adenoids (lymph tissue that lies on each side of the back wall of the nose and the upper part of the throat) may be acting as a reservoir for the infection-causing bacteria. In these cases, doctors sometimes recommend removing the adenoids or inserting tubes into the child’s ears (myringotomy; see page 418).
Cholesteatoma
A cholesteatoma is an abnormal growth of the skin of the eardrum into the middle ear. The skin forms a cyst that fills with dead skin cells shed by the eardrum. Over time, the cyst becomes infected repeatedly and can erode the bone that lines the middle ear cavity and the delicate bones in the middle ear. A cholesteatoma can also erode the protective bone between the middle ear and the facial nerve, damage the areas of the middle ear responsible for balance and hearing, and damage the brain, including its covering and blood supply. A cholesteatoma may be congenital (present at birth), but it is usually caused by recurring middle ear infections.
Symptoms
The symptoms of a cholesteatoma can include headache, earache, weakness of the facial muscles, dizziness, and mild to moderately severe conductive hearing loss (see page 1016). In some cases, pus seeps from the ear. If a cholesteatoma erodes the roof of the middle ear cavity, you may have paralysis of the facial nerves, a false sense that you or your surroundings are moving (vertigo; see page 1012), or profound sensorineural hearing loss (see page 1016). A cholesteatoma that infects the brain can produce a pocket of pus between the membrane covering the brain and spinal cord and the bones of the skull or spine (epidural abscess; see page 695) or inflammation of the membranes that surround and protect the brain and spinal cord (meningitis; see page 692). An abscess also can form behind the ear.
Diagnosis
To diagnose a cholesteatoma, a doctor will take a detailed health history and examine the affected ear with a lighted viewing instrument called an otoscope. If the doctor suspects that you have a cholesteatoma, he or she will refer you to an otolaryngologist (a doctor who specializes in disorders of the ear, nose, and throat). The otolaryngologist will examine you and may perform hearing tests (see page 1016).
Treatment
To treat a cholesteatoma that is small or at an early stage, the otolaryngologist may remove it and thoroughly clean out the middle ear cavity in a relatively simple surgical procedure performed through the ear canal. If the cholesteatoma is large or at a later stage, damage to the middle ear may be extensive. In this case, removal of the cholesteatoma is more complicated, involving a procedure to rebuild the hearing structures, repair the broken eardrum, and clean out the mastoid bone (the bone behind the ear), often leaving it open to the ear canal. If your hearing is badly damaged by the cholesteatoma or its treatment, a hearing aid (see page 1018) may be helpful.
Cholesteatomas sometimes recur. For this reason, the otolaryngologist probably will want to examine your ears at least once a year.
Disorders of the Outer Ear
The lining of the outer ear canal is an extension of the skin of the visible ear. Most disorders of the outer ear are skin disorders. While the symptoms can be bothersome, disorders of the outer ear are generally not as serious as middle and inner ear disorders because they do not permanently affect the delicate mechanisms of hearing and balance.
The outer ear
Earwax Blockage
Glands in the outer ear canal produce wax to protect the canal from bacteria, dirt, and other debris. Usually, shedding of skin cells in the ear canal causes the wax and debris in the ear canal to fall out. However, in some people, excessive wax production, abnormal shedding of skin