Jay Dolitsky MD FAAP Ped ENT www.MDK.com
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Male: Sometimes a kid goes to a doctor and he sees like a whity, waxy material and the whole drum seems to be infused by this. And he thinks there is something growing behind the drum and the kid has a good history and they had maybe a history of a perforation or discharge in the ear, what is that all about? Dr. Dolitsky: Well, the thing of concern when you hear about a white thing around the eardrum is that there maybe a small cyst behind the ear drum which we call like colesteotoma. A colesteotoma is a benign skin cyst in the middle ear and it is benign in terms of it does not metastasize like a tumor. However, it does have a tendency over a period of time to grow and since the middle ear is a very confined space with important structures in it such as the bones of hearing, which we call the oscicles, the facial nerve. We don’t want a structure in there growing and growing and potentially damaging it. So the worst possible thing we need here about a white substance behind the ear drum is a colesteotoma. There are other things that can be confused with a colesteotoma, white plaques on the ear drum which we call myringosclerosis or some people call tympanosclerosis are just basically scars on the eardrum that usually have very little clinical significance. Also when you have an external ear infection, sometimes you get white debris in the external ear canal that can also line the outside of the eardrum. The external serves as the ear drum and that is a simple condition that is more commonly known as a swimmers ear and can be removed with drops and suctioning. And that is a completely different process than the colesteotoma but the one thing of concern would be this colesteotoma and that is if it is behind the eardrum. Male: How do you remove that? Dr. Dolitsky: A colesteotoma will never go away on its own. It has to be removed. It may not be an emergency but the only way to get rid of it is to remove it surgically and depending on the extent or the size of the colesteotoma. It may be confined just to the middle ear or to the mastoid, which is the bone behind the ear that communicates with the middle ear. And depending on the size and extent of colesteotoma, it maybe able to be removed just by lifting up the eardrum through the external ear canal, again a surgical procedure or an incision may be have to made behind the ear as well to get into the mastoid and clean it out. So it depends on the extent of the colesteotoma. When a colesteotoma is suspected it is a good idea to get a CAT scan to help define the extent. Male: A pretty thorough workup, because you know what you want, you don’t do it blindly, is that correct? Dr. Dolitsky: Correct.