| Tympanic Membrane, Middle Ear and Mastoid Disease Chronic Otitis Media and Cholesteatoma Etiology and Diagnosis Chronic otitis media can also lead to a cholesteatoma. A cholesteatoma is a skin growth that occurs behind the eardrum. It is usually caused by repeated ear infections associated with poor Eustachian tube function. Over time, the cholesteatoma increases in size and destroys the delicate middle ear bones. Eventually, it may erode into the inner ear and cause permanent hearing loss or dizziness. It may grow to involve the facial nerve causing facial paralysis. In some instances, cholesteatomas can expand up into the brain. Chronic otitis median and/or cholesteatoma are a serious conditions that requires prompt treatment. Initially, this involves careful cleaning of the ear, antibiotics, and eardrops. Often, computed tomography (CT scan) is helpful to define the extent of the disease. This also can act as a road map for surgery. Treatment A canal-wall-up procedure means that the ear canal is maintained and the location of the eardrum is in its normal location. Thus, when a physician not specialized in ear surgery looks in your ear canal, he may not know that you have had surgery. The downside to having a canal-wall-up tympanoplasty with mastoidectomy is that residual cholesteatoma within the middle ear or mastoid space may grow asymptomatically, until it reaches an ext remely large and dangerous size. So, most physicians who perform canal-wall-up procedures recommend a “second-look” procedure 6-12 months after the first surgery. This is basically the same as the first surgery but since most of the work has been done, it is usually a somewhat shorter procedure. A canal-wall-down procedure means that the ear canal is removed and opened up into the mastoid cavity behind the ear. This is called a mastoid bowl. In most cases, it is quite obvious to any physician who looks in the ear that surgery has been performed because the ear canal is no longer a tube, it is a large cavity. A standard part of this procedure is a meatoplasty. This means that the ear canal is surgically enlarged, in order to permit proper aeration of the mastoid bowl and reduce the chances of infection. Most patients need to have their mastoid bowl cleaned out by an otolaryngologist every 6-12 months. This is because the normal process of the ear canal to extrude earwax and debris has been disrupted. A second look operation is usually not needed after a canal-wall-down tympanoplasty with mastoidectomy, because any residual cholesteatoma can be easily seen and removed in clinic. With either a canal-wall-up or canal-wall-down, an ossicular chain reconstruction to rebuild the middle ear bones may be considered. This can be done at the time of the first surgery or at a second surgery 6-12 months later. This length of time is preferred because it gives time after the first surgery for the ear to heal. If a second surgery for ossicular chain reconstruction is planned, many surgeons will place a piece of Silastic into the middle ear space. This is a thin sheet of rubbery plastic that prevents scar tissue from forming between the eardrum and the inner ear, simplifying the second surgery. Results of Surgery For inquiries or more information, please contact: John S. Oghalai , MD Clinic: 713-798-3200 Tympanic Membrane Middle Ear and Mastoid Disease: Information Page Tympanic Membrane, Middle Ear and Mastoid Disease: Photo Gallery Cochlear Mechanics and Hearing Loss Laboratory Home Page | Department Home Page | BCM Public | BCM Intranet | Privacy Notices | Contact BCM | BCM Site Map | ©2001-2006 Baylor College of Medicine
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