Removing cholesteatomas

Cholesteatomas grow very slowly and, in the majority of cases, it is necessary to surgically remove them. This procedure is in the vast majority preventive, to avoid complications after 10 or 20 years. Some slow-evolving cholesteatomas are simply followed with regularly cleaning (e.g. a few times a year) in the clinic.

A procedure may last for only an hour, but it usually takes several hours. A procedure for cholesteatomas is usually performed with an outpatient admission or with one overnight stay in the hospital.

An incision is made behind the outer ear, and the flake-filled sac is removed from the mastoid and the middle ear.

The flake-filled sac can be very heavy. The sac will have become very fragile and can tear easily when touched. In these cases, we are not 100% certain after completing the procedure that all cells from the cholesteatoma have been removed. A few cells are sometimes left, which can begin growing again. In order to detect a 'residual cholesteatoma', we often do an exploratory procedure one and half years later (or one year for children). We also often do a NMR three years later. Both options have advantages and disadvantages. Some hospitals decide to do a follow-up procedure (exploratory procedure) on every patient. Other hospitals decide to perform an NMR to follow all cholestatoma patients. At our hospital, our decision depends on the particular patient.

Another problem that may present is a 'recurrent cholestatoma'. In this case, everything turns out well after the operation, but, after a year, another superficial pitting is found. This pitting can become deeper and deeper over the years, until it finally results in another choleastoma. To prevent this from happening, we use techniques such as reinforcing the eardrum with cartilage and packing of the mastoid. But even so, some eardrums (not many, fortunately) that have the stubborn tendency to collapse inwards.

In addition to these two problems, the procedure also has rare risks such as:

• Hearing loss
• Balance problems
• Paralysis of the facial nerve (facial paralysis): we always monitor the nerves during the procedure, which will warn us when we start to get close to the nerve.
• Tinnitus
• Depending on the size and location of the cholesteatoma: risks such as meningitis or a cerebral fluid leak. This is extremely rare.

Not performing the procedure carries the exact same risks in the long-term.

Every cholesteatoma is different, so please know that this is not the case for every cholesteatoma. For cholesteatoma cases, it is especially important to discuss everything in detail at the clinic.

• Patients wear a bandage for four days and usually come in three or four times for a check-up.
• Recovery usually takes anywhere between four and six weeks.
• You may not do sports, heavy duty at work or fly in an airplane for three weeks. You may not swim for four to six weeks.
• Afterwards, you will receive long-term, annual follow-up.

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Latest publication date: 13/08/2024
Supervising author: Dr Vermeiren Judith