The ear drum may develop a hole, (or perforation), due to trauma or infection. In most instances, ear drum perforations caused by infection will close after the infection resolves. However, some perforations are too large to close spontaneously and will become infected causing drainage from the ear.

Sometimes, a perforation has been there for several months or years and skin within the ear canal will grow into the middle ear causing a cholesteatoma. A cholesteatoma is a cyst made up of skin. There is usually a large amount of skin debris associated with the cholesteatoma. A cholesteatoma is a slow-growing mass that may erode adjacent structures including the middle ear bones, (malleus: "ammer", incus: "anvil", and stapes: "stirrup") and the bone surrounding the ear next to the brain. Cholesteatomas may also erode into the balance and hearing organs of the inner ear. For this reason, cholesteatomas are best removed early, once they are discovered. Many times, Dr. Shea will try to control infection prior to removing the cholesteatoma in order to make the operation more successful.

In rare instances, a cholesteatoma may form due to skin tissue that is trapped behind the tympanic membrane during fetal development. In this instance, there will be no history of tympanic membrane perforation or significant ear infections. However, the cholesteatoma can be quite extensive.

To decide what form of therapy is best, Dr. Shea will examine your ear under an operating microscope in the office. This will allow better visualization of the problem and give clues to the extent of your ear disease. When a cholesteatoma is suspected of involving more than the area behind the ear drum, a computed tomography (CAT) scan will be used. This is a special x-ray that allows Dr. Shea to examine in detail the area behind the ear drum as well as the area of the mastoid bone which is located directly behind the ear.

Dr. Shea will order a hearing test to assess any hearing loss that may be present prior to therapy. If you have signs of dizziness or unsteadiness associated with the cholesteatoma, Dr. Shear may also order some other specialized tests of the balance system to help determine the extent of ear disease.

If medical therapy is unsuccessful, or if the extend of the disease determined by your evaluation is thought to involve the mastoid, Dr. Shea will discuss with you surgical therapy tailored specifically to your problem. This therapy may be directed at the area just behind the ear drum or to the mastoid bone behind the ear, or both.

If an operation such as this is necessary, it is important for you to fully understand the complexity and the risks associated with these surgeries. Dr. Shea has been specifically trained to perform this surgery using microsurgical instruments on the ear and mastoid. This is done with a microscope. Many times, in order to successfully remove all the chronic disease in your ear, one of the ear bones will be disconnected to insure complete removal of disease and prevent further complications. Once your ear disease is under control, your doctor will be able to, in many instances, reconstruct the hearing bones and restore much of the hearing lost to the chronic ear infection.

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