To date, many varieties of cancer are known. One such is cholesteatoma. This formation is most often found in the middle ear, although in isolated cases it is found in the sinuses located near the nose. It consists of cholesteatoma from dead epithelial cells and cholesterol.
Types of cholesteatoma
Cholesteatom tumor is characterized by a three-layered structure. In the center of formation like a nucleus there is a cluster of detritus, a substance containing infectious agents, and a putrefactive odor.
Then comes a layer consisting of epithelial plates and cholesterol. Then follows the outer shell - the matrix, consisting of a connective tissue capsule and a multilayered plate of keratinized epithelium.
Cholesteatom is classified according to several principles. For example, depending on the location is distinguished:
- Cholesteatom of the ear;
- of the temporal bone;
- of the brain.
The photo depicts the cholesteatoma of the ear
In addition, the cholesteatoma can be:
- Congenital;
- Purchased.
Congenital cholesteatoma is usually located behind the wall of the tympanic membrane on the temporal bone, but it can also be located in the ventricles of the brain. As a rule, it is diagnosed in early childhood. A similar tumor develops as a result of improper development of epithelial tissue. It is often called a pearl tumor for a smooth, pearl-like surface.
Causes of
The causes of congenital or true cholesteatoma are embryonic abnormalities. Acquired types of tumors are formed for the following reasons:
- Damage to the ear structure;
- Prolonged otitis media;
- Injuries of the tympanic membrane;
- Narrowing of the aisle or its obstruction;
- Inflammatory processes in the auditory tube.
According to medical data, about 90% of the cases of acquired cholesteatoma have originated from as a result of chronic forms of middle ear of osteitis of purulent origin .
In general, specialists identify two mechanisms for the formation of the acquired cholesteatom tumor:
- The first mechanism is realized when the lumen of the auditory canal is broken due to eustachiitis;
- The second mechanism is caused by the ingrowth of the epithelium of the external auditory tube into the middle ear cavity.
How does the disease manifest itself?
Cholesteatoma in the initial stages is characterized by predominantly asymptomatic development. But gradually with the development of the tumor process, the patient has an eruption in his ear, accompanied by a pain syndrome of a different nature.
Soreness can be firing, pressing, blunt or aching, and it is always accompanied by a slight decrease in hearing abilities. In other words, the patient begins to notice some deterioration in hearing. Disturb and other signs of the disease.
- Along with pain in cholesteatoma, headaches may be troubling, and if the inflammation in the inner ear has developed in parallel with the tumor, dizziness also occurs.
- A scant amount of putrefactive mucus that contains microscopic white lumps stands out from the ear.
Hearing problems with the tumor process are due to several factors.
Diagnostics
Diagnostic procedures are appointed by an otolaryngologist, neurologist, neurosurgeon and oncologist. It is quite possible to detect cholesteatoma only by an x-ray scan of the skull and CT scan.
In addition, during the diagnosis can resort to otoscopy, probing of the middle space, the study of the vestibular apparatus and auditory capabilities.
Treatment Methods
To eliminate cholesteatom formation, therapeutic measures of a conservative and operational nature can be undertaken. Conservative therapy is possible only if the cholesteatoma is small and localized above the tympanic membrane.
In other clinical cases, the treatment of cholesteatoma is possible only by surgical means.
Conservative
Conservative therapy is based on various washes with enzymatic solutions or boric acid( alcohol solution).
Similar solutions soften the tumor and promote its removal from the ear canal in a natural way.
After washing the tumor, the patient is recommended to undergo a course of physiotherapeutic treatment. If there is a need, the patient is plastics of the ear shell.
If the above-mentioned washes are started on time and will be carried out regularly, then there are all chances for a positive effect of therapy and further recovery.
Along with washing, anti-inflammatory and analgesic preparations are prescribed, as well as means for lowering blood pressure, improving blood circulation and other medications.
The specific set of medicines depends on the exact location of the education and the degree of its development.
Operational
If conservative therapies do not give a positive result, then they resort to treatment in operational ways. Most often, to remove the tumor, a mastoidectomy is performed, involving the dissection of the tympanic membrane and subsequent removal of the tumor tissue. If the lesion has spread to the auditory ossicles or nearby bone patches, then parts thereof are also removed.
To ensure that the patient does not lose hearing after the operation due to damage to the tympanic membrane, timpanoplasty is performed as the final stage of mastoidectomy. If the cholesteatoma has spread to a larger area, the area of surgical intervention expands.
One of the modern ways to treat cholesteatoma is endoscopy. It is carried out with the help of special endoscopic instruments and a surgical microscope. Such intervention refers to minimally invasive procedures, since it is performed through small punctures.
This approach to treatment excludes possible damage to the integrity of the facial nerve or the membrane of the brain, and significantly reduces the period of postoperative recovery and does not leave cosmetic defects.
Complications and prognosis of
If no timely therapeutic measures are taken with respect to the tumor process, the cholesteatoma begins to grow, gradually filling the ear structures, destroying the tissues of the labyrinth. Then the tumor penetrates into the canal of the facial nerve, which provokes paresis.
Preventative measures
Prophylaxis of cholesteatoma is as follows:
- Temper, then such a nuisance as a runny nose will not bother you;
- It is necessary to take timely measures for the treatment of colds, even a minor runny nose needs to be healed to the end. If rhinitis is not amenable to treatment, it is unacceptable to abuse vasoconstrictor drugs. In this situation it is better to consult an otolaryngologist;
- In the case of pediatric otitis, parents should remember that antibiotic therapy must be included in the treatment process;
- Medical examinations should be regular, because often a disturbing migraine may not be a banal fatigue, but a manifestation of cholesteatoma.
A careful attitude to one's own health will help to avoid dangerous diseases.