Cholesteatoma, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

By Kenneth Kee

This book describes Cholesteatoma, Diagnosis and Treatment and Related Diseases
Cholesteatoma is a form of skin cyst that is located in the middle ear and mastoid bone in the skull.
This lesion is incorrectly named, as it is not exactly a tumor nor is it made of cholesterol but rather it is a three-dimensional collection of epidermal and connective tissues within the middle ear.
Its importance lies in the fact that it grows independently and can be locally invasive and destructive, mainly affecting the bones of the middle ear.
Bone erosion happens mainly by pressure but release of osteolytic enzymes has been identified at the peripheral margins of the lesion.
Osteolytic activity seems to be enhanced by the presence of infection.
The (normally) unilateral lesion can give rise to a spectrum of disorders, ranging from painless otorrhoea (discharge from the ear) through to serious central nervous system complications.
Classification
Congenital cholesteatoma
This happens when squamous epithelium becomes trapped within the temporal bone during embryogenesis.
It enlarges, resulting in conductive hearing loss either through blockage of the Eustachian tube or by enclosing the ossicular chain.
Primary acquired cholesteatoma
It is thought that chronic negative middle-ear pressure because of an abnormal function of the Eustachian tube causes the tympanic membrane to be 'sucked back' and retract.
As this process persists, there is erosion of the lateral wall of the epitympanum , producing a slowly enlarging defect.
A pocket covered by squamous, non-keratinizing epithelium is then formed.
The erosion often persists, as the ball of epithelium grows, to enclose the ossicles and may spread into the mastoid bone, lateral semicircular canal, middle and posterior cranial fossa.
Secondary acquired cholesteatoma
This happens as a result of injury to the tympanic membrane, such as perforation due to acute otitis media (AOM) or damage, or because of surgical manipulation of the drum.
Squamous epithelium may be unintentionally implanted by the injury so activating the process of cellular growth leading to cholesteatoma formation.
Symptoms:
1.Dizziness
2.Drainage from the ear, which can be chronic
3.Hearing loss in one ear
Small lesions are linked with a progressive conductive hearing loss but, as the lesion grows and erodes into adjacent structures, there may be other features such as vertigo, headache and facial nerve palsy.
Diagnosis:
An ear exam may show a pus pocket or perforation in the eardrum, often with drainage.
A deposit of old skin cells may be visualized with an otoscope
1.Hearing to detect loss
2.CT imaging for option of surgery
Treatment
Cholesteatomas very often persist to grow if they are not resected.
Surgery is most often successful.
Medical treatment is reserved for those patients who refuse surgery or for whom a general anesthesia would be too hazardous owing to co-morbidity.
In these patients, regular ear cleaning with treatment of infections (topical ± systemic antibiotics) is advised
Surgical treatment
The purpose of surgery is to remove the cholesteatoma.
Surgery involves a general anesthesia and an incision behind the ear and in the auditory meatus.
There are two methods utilized:
1.Open technique (tympanomastoidectomy): this is a longer and more involved operation that involves removal of a number of structures
This is the more successful of the two types of procedure in terms of cholesteatoma removal and hence a single procedure is normally sufficient.
2.Closed technique (tympanoplasty): this method is linked with a better end result with regards to cosmetic appearance
There is a higher risk of persistent or recurring cholesteatomas

TABLE OF CONTENT
Introduction
Chapter 1 Cholesteatoma
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diag

• Language: English
• Publisher: Kenneth Kee
• Release date: Sep 17, 2018
• ISBN: 9780463325728

Kenneth Kee

Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

Book preview

Cholesteatoma,

A

Simple

Guide

To

The Condition,

Diagnosis,

Treatment

And

Related Conditions

By

Dr Kenneth Kee

M.B.,B.S. (Singapore)

Ph.D (Healthcare Administration)

Copyright Kenneth Kee 2018 Smashwords Edition

Published by Kenneth Kee at Smashwords.com

Dedication

This book is dedicated

To my wife Dorothy

And my children

Carolyn, Grace

And Kelvin

This book describes Cholesteatoma, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

(What The patient Need to Treat Cholesteatoma )

This eBook is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.

If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

Thank you for respecting the hard work of this author.

Introduction

I have been writing medical articles for my blog: http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.

My purpose in writing these simple guides was for the health education of my patients.

Health Education was also my dissertation for my Ph.D (Healthcare Administration).

I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog: http://afamilydoctorstale.blogspot.com.

This autobiolographical account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Disorders into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

From which many free articles from the blog was taken and put together into 800 eBooks.

Some people have complained that the simple guides are too simple.

For their information they are made simple in order to educate the patients.

The later books go into more details of medical disorders.

The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

Since 2013, I have tried to improve my spelling and writing.

As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

I apologize if these repetitions are irritating to some readers.

Chapter 1

Cholesteatoma

What is Cholesteatoma?

Cholesteatoma is a form of skin cyst that is located in the middle ear and mastoid bone in the skull.

This lesion is incorrectly named, as it is not exactly a tumor nor is it made of cholesterol but rather it is a three-dimensional collection of epidermal and connective tissues within the middle ear.

Its importance lies in the fact that it grows independently and can be locally invasive and destructive, mainly affecting the bones of the middle ear.

Bone erosion happens mainly by pressure but release of osteolytic enzymes has been identified at the peripheral margins of the lesion.

Osteolytic activity seems to be enhanced by the presence of infection.

The (normally) unilateral lesion can give rise to a spectrum of disorders, ranging from painless otorrhoea (discharge from the ear) through to serious central nervous system complications.

Classification

Congenital cholesteatoma

This happens when squamous epithelium becomes trapped within the temporal bone during embryogenesis.

It enlarges, resulting in conductive hearing loss either through blockage of the Eustachian tube or by enclosing the ossicular chain.

Primary acquired cholesteatoma

The exact pathophysiology of these lesions is not absolutely definite but it is thought that chronic negative middle-ear pressure because of an abnormal function of the Eustachian tube causes the tympanic membrane to be 'sucked back' and retract.

As this process persists, there is erosion of the lateral wall of the epitympanum (the upper portion of the tympanic cavity which has the head of the malleus and the body of the incus), producing a slowly enlarging defect.

A pocket covered by squamous, non-keratinizing epithelium is then formed.

The erosion often persists, as the ball of epithelium grows, to enclose the ossicles and may spread into the mastoid bone, lateral semicircular canal, middle and posterior cranial fossa.

Secondary acquired cholesteatoma

This happens as a result of injury to the tympanic membrane, such as perforation due to acute otitis media (AOM) or damage, or because of surgical manipulation of the drum.

Squamous epithelium may be unintentionally implanted by the injury so activating the process of cellular growth leading to cholesteatoma formation.

Spectrum of otitis media

Otitis media (OM) is an umbrella term for a group of complicated infective and inflammatory disorders affecting the middle ear.

All OM affects the pathology of the middle ear and middle ear mucosa.

OM is a leading cause of medical care worldwide and its complications are essential causes of preventable hearing loss, mostly in the developing world.

There are differing subtypes of OM.

These are:

1. AOM,

2. Otitis media with effusion (OME),

3. Chronic suppurative otitis media (CSOM),

4. Mastoiditis and

5. Cholesteatoma.

They are normally depicted as discrete diseases but in reality there is a great degree of overlap between the different forms.

OM can be regarded as a continuous spectrum of diseases:

AOM is acute inflammation of the middle ear and may be produced by bacteria or viruses.

A subtype of AOM is acute suppurative OM, featured by the presence of pus in the middle ear.

In around 5% patients the eardrum has a perforation.

OME is a chronic inflammatory disorder without acute inflammation, which often accompanies a slowly