Cholesteatoma Surgery

Cholesteatoma Surgery: Ear health is one of the important elements that directly affects quality of life. Pathologies occurring in the outer and middle ear can deeply affect not only hearing ability but also balance, brain health, and daily social communication. Cholesteatoma, one of these diseases, is a chronic condition that develops especially in the middle ear and can lead to progressive and serious complications. This abnormal cell mass, which can erode bone tissue over time, cannot be treated with medication alone, so the most effective solution is surgery.

ENT Specialist Prof. Dr. Ozan Seymen, who serves in his own clinic in Istanbul, combines advanced microscopic and endoscopic techniques in cholesteatoma surgery to provide his patients with successful and permanent results in both auditory and structural terms.

What is Cholesteatoma?

Cholesteatoma is defined as a mass consisting of skin cells formed by abnormal growth of the external ear canal epithelium towards the middle ear, which is benign but can progress aggressively. Although the word cholesteatoma appears to be related to “cholesterol”, it actually contains no cholesterol; it is characterized by the accumulation of dead epithelial cells and the bone-eroding effect of enzymes secreted by these cells.

There are congenital (present at birth) or acquired types. The most common type is acquired cholesteatoma and it usually occurs due to chronic ear infections, eustachian tube dysfunction, or ear drum retractions.

It can cause serious complications that may reach the ear ossicles, inner ear, facial nerve, meninges, and even the brain by eroding surrounding tissues over time. Therefore, early diagnosis and surgical intervention are critically important.

What Symptoms Does Cholesteatoma Present With?

Cholesteatoma usually starts silently and progresses slowly. However, as it progresses, it can manifest itself with some characteristic symptoms. These symptoms include:

• Persistent or recurrent foul-smelling ear discharge
• Hearing loss (especially conductive type)
• Feeling of fullness or pressure in the ear
• Dizziness and balance problems
• Ringing in the ear (tinnitus)
• Facial paralysis in advanced cases
• Rarely, headache, meningitis, and brain abscess

These symptoms can be confused with other ear diseases. Therefore, detailed otoscopic examination, audiological tests, and especially high-resolution temporal bone CT (computed tomography) are very important for correct diagnosis.

Prof. Dr. Ozan Seymen, with his expertise in ear diseases, ensures early detection of cholesteatoma and shapes treatment planning according to individual patient anatomy.

How is Cholesteatoma Surgery Performed?

Treatment of cholesteatoma with medication is not possible; therefore, a definitive solution is obtained only surgically. The goal is to completely remove the diseased tissue, preserve or repair the hearing mechanism, and prevent complications.

Surgery is performed with microscope or endoscope support, using different techniques depending on the extent of the disease and the condition of the bone. The most commonly applied surgical methods are:

1. Tympanomastoidectomy

This method is used to clean cholesteatoma foci in both the middle ear and mastoid bone. During surgery, an incision is made behind the ear and the diseased tissue is removed.

Canal Wall Up (CWU): The rear wall of the ear is preserved. It is aesthetically advantageous, but the risk of recurrence is slightly higher.

Canal Wall Down (CWD): The rear wall of the ear is removed. It is a more radical and safe approach, but an open mastoid cavity is left. May require long-term care.

2. Revision Surgeries

Applied especially in recurrent cholesteatomas. Planned according to the results of previous surgeries.

3. Hearing Repair (Ossiculoplasty)

If the ear ossicles have been eroded due to cholesteatoma, the hearing mechanism is reconstructed. The patient’s own tissues or special prostheses can be used.

Prof. Dr. Ozan Seymen performs cholesteatoma surgeries precisely with microscopic and endoscopic systems, aiming for both complete cleaning of the disease and preservation of the best possible hearing level.

Recovery Process After Cholesteatoma Surgery

The recovery process after cholesteatoma surgery varies depending on the type of surgery performed and the patient’s general health condition. On average, the patient can return to daily life within 1-2 weeks. However, complete recovery and settling of the hearing level may take several months.

Things to Consider in the Post-Surgery Process:

• In the first few days, dizziness, fullness in the ear, and mild pain may be experienced. These are normal and decrease within a few days.
• It is very important that water does not get into the ear. Care should be taken during showering, and the ear should not be cleaned without doctor’s recommendation.
• Ear dressings should be done regularly, and check-ups should not be missed.
• Antibiotics and pain relievers should be used regularly.
• Air travel, diving, and heavy physical activities should be avoided for the first few weeks.

Prof. Dr. Ozan Seymen closely follows his patients in the post-operative process and plans for hearing tests and second-stage surgeries when necessary.

Risks and Complications of Cholesteatoma Surgery

Cholesteatoma surgeries require careful and sensitive surgical experience, especially in advanced cases. Although rare, some complications may develop after surgery:

Recurrence: The recurrence rate is higher especially in the canal wall up (CWU) technique. Therefore, regular follow-up is important.

Hearing loss: Pre-operative hearing status and the spread of cholesteatoma are determinative. Losses can be minimized with the surgeon’s meticulous work.

Facial nerve damage: The facial nerve runs very close inside the ear. Experienced surgeons minimize this risk.

Dizziness: Temporary vertigo may be experienced if the inner ear is affected.

Tympanic membrane (eardrum) perforation: In some cases, the membrane can be reconstructed.

Prof. Dr. Ozan Seymen evaluates each case individually, selects the most appropriate surgical technique, and applies advanced imaging and surgical planning to prevent complications.

Is cholesteatoma dangerous?

Yes. If left untreated, it can cause hearing loss, facial paralysis, progress to the meninges causing meningitis, or life-threatening complications.

Does hearing improve after cholesteatoma surgery?

It varies depending on the situation. If the ossicular chain is not damaged, hearing can be largely preserved. The hearing mechanism can be repaired with ossiculoplasty.

Does cholesteatoma recur after surgery?

Yes, there is a risk of recurrence especially in those who have surgery at an early age and in the CWU technique. Therefore, periodic check-ups are very important.

Does the surgery leave a scar?

The incision made behind the ear is closed with aesthetic sutures. Since the scar is hidden in the scalp, it becomes indistinct over time.

Does tinnitus continue after surgery?

If tinnitus is caused by the affected auditory nerves, it may continue. However, there may be a decrease in tinnitus with the cleaning of cholesteatoma.

Cholesteatoma surgery is a surgical intervention that is vitally important not only to correct hearing loss but also to prevent serious neurological complications. When done at the right time, with the right technique, and by an experienced surgeon, it provides long-term improvement both functionally and structurally.

ENT Specialist Prof. Dr. Ozan Seymen, who serves in his own clinic in Istanbul, aims to fully control the spread of the disease in cholesteatoma surgeries, to preserve hearing function at the highest level, and to provide his patients with a safe treatment process.

If you are experiencing recurrent ear discharge, hearing loss, or a feeling of fullness in the ear, you can regain your health by consulting Prof. Dr. Ozan Seymen without delay for a detailed examination and treatment planning.