Cholesteatoma can be managed in a variety of ways, but definitive removal of the skin or cyst typically requires surgical intervention. Before surgery, your ENT specialist may need to carefully clean your ear and prescribe medications to help stop the drainage. These medications (oral antibiotics) may be taken by mouth, applied directly to the ear (topical antibiotics), or both. It is advised that you keep the ear dry while treating these infections.
The specific type of surgery depends on what part of the ear is involved with the cholesteatoma. Sometimes the extent of disease is clearly seen on the office exam. Other times imaging, often a CT scan, helps to define where the cholesteatoma is located. CT scans are a collection of X-rays that provide good detail on the bony anatomy of the ear. A hearing test, or audiogram, should be obtained. Other tests like an MRI or balance testing are less commonly required.
The primary goal of cholesteatoma surgery is to remove the skin, clear the infection, and create a dry, safe ear. This may involve reconstructing the eardrum, removing bone behind the ear, or reconstructing the hearing bones. In some cases, a second surgery may be required to make sure all the cholesteatoma has been removed before the hearing bones can be rebuilt.
A second surgery will typically be performed six to 12 months after your first surgery, if necessary. Your hearing might temporarily worsen after the first surgery if the reconstruction of your hearing bones is delayed. There are many factors that contribute to how well you hear after surgery, and these should be discussed with your ENT specialist.
Surgery is generally performed in an outpatient setting, but some patients may require an overnight stay. In rare cases of serious infection, a prolonged hospitalization for antibiotic treatment may be required. Interventions for facial nerve weakness or to control dizziness are rarely needed. Time off from work is typically one to two weeks. After surgery, follow-up office visits will be needed to clean your ear, recheck your hearing, and evaluate the results. Cholesteatoma requires long-term surveillance to check for recurrence.