Cholesteatoma (Skin Cyst in the Middle Ear) and Endoscopic (Keyhole) Ear Surgery
Author of Article:
Associate Professor Nirmal Patel specialises in keyhole (Endoscopic Ear Surgery) management of cholesteatoma since 2012 when the first surgeries were performed in Australia. He was the first Australian member of the International Working Group on Endoscopic Ear Surgery (IWGEES https://www.iwgees.org), the premier international group for keyhole surgery and is now the Australian Board member for the group. Nirmal is also a founding member of Australia’s first Research Collaboration (Sydney Endoscopic Ear Surgery Research Group) which has run 7 courses to teach local and international surgeons keyhole ear surgery. He has performed over 600 endoscopic (keyhole) ear operations.
In order to understand chronic ear infection, one must have some knowledge of the hearing mechanism.
Anatomy of the Outer Ear
The auricle and the external ear canal make up the outer ear. Here, the sound waves are collected and amplified, to be transmitted to the eardrum.
Anatomy of the Middle Ear
The section behind the eardrum and before the inner ear is the middle ear, home to the three hearing bones (the hammer, anvil and stirrup). Vibrations from the sound waves collected by the outer ear are collected, and transmitted to the fluid-filled space of the inner ear by the three bones. Lining the middle ear chamber is a membrane similar to your nasal lining. The membrane contains blood vessels and mucous glands, and is punctuated by the Eustachian tube, which connects the middle ear to the back of the nose.
The Eustachian tube is needed to equalise pressure in the middle ear when differentials occur. Opening your Eustachian tube during a plane flight or other altitude change results in a ‘popping’ sensation and reduction of pressure inside your ear.
Anatomy of the Inner Ear
The chamber behind a dense layer of bone is the inner ear. It is lined with a delicate membrane and filled with fluid, which transfers the vibration of the stirrup bone into fluid waves, which are transformed into electrical impulses by hair cells in the cochlea.