Cholesteatoma — Surgery and Treatment Zagreb

Diagnosis

What is Cholesteatoma?

Cholesteatoma is a rare but serious condition in which skin tissue accumulates within the middle ear in the form of a cyst. It is a benign but extremely invasive lesion that destroys the healthy structures of the ear it encounters — behaving like a tumour. Initially the eardrum and ossicles are affected, while later, if left untreated, the disease can spread to the organ of hearing and balance, the facial nerve, the skull base and the brain.

Cholesteatoma usually appears as a consequence of recurrent middle ear infections, inflammation, untreated eardrum perforations, or may be congenital. It is the most severe form of chronic inflammatory changes of the middle ear. This insidious condition — an accumulation of skin cells in the middle ear — silently erodes everything around it and causes serious damage. It can be recognised by symptoms such as ear discharge or unpleasant odour, reduced hearing, frequent infections or bleeding.

Symptoms of Cholesteatoma

Without adequate treatment, cholesteatoma can lead to serious complications. The most common symptoms include:

Chronic ear discharge, often with an unpleasant odour
Progressive hearing loss
Occasional pain or pressure in the ear
Dizziness or instability
Tinnitus (ringing in the ear)

Possible Complications Without Treatment

Erosion of the ossicles with resulting hearing loss
Destruction of surrounding bony structures
Vertigo due to damage to the inner ear
Facial nerve paralysis
Meningitis and other intracranial complications, including purulent abscesses
Permanent hearing loss

Endoscopic Approach

Endoscopic Cholesteatoma Surgery at Poliklinika Malić

At Poliklinika Malić we apply endoscopic cholesteatoma surgery — a modern method that enables effective treatment of this potentially dangerous disease with maximum preservation of functional structures. Using the endoscope, Dr. Malić can reach areas that are practically invisible with a microscope, which is crucial because cholesteatoma tends to "hide" in difficult-to-access recesses within the middle ear. This significantly reduces the recurrence rate of this serious condition because the operation is more precise and thorough.

The current trend in cholesteatoma surgery is minimally invasive endoscopic surgery. Endoscopic surgery has developed as an alternative to open ear surgery — it does not require external incisions as the entire operation is performed through the ear and is feasible in situations where the cholesteatoma is in an early stage and limited to certain parts of the ear. It is a less invasive method than open microscopic surgery with better and more precise visualisation, which can result in faster recovery with fewer complications.

More Precise Visualisation

4K endoscopes provide a detailed view of hard-to-reach areas of the middle ear — the surgeon sees "around the corner" and controls the disease more thoroughly than ever.

Access Through the Ear Canal

In appropriate cases, incision behind the ear and drilling of the mastoid bone is avoided — we use the ear canal as the natural pathway.

More Complete Disease Control

Endoscopes allow examination "around the corner" and better disease control in all parts of the middle ear — lower recurrence rate.

Preservation of Healthy Tissue

Targeted removal of pathology with maximum preservation of healthy structures — better possibility of preserving or reconstructing the ossicles.

Improved Hearing Outcomes

Better visibility enables more precise reconstruction of the ossicles and a higher rate of hearing improvement after the procedure.

Faster Recovery

Less tissue trauma results in shorter recovery and less postoperative pain compared with classical microsurgery.

Individualised Approach

Surgical Techniques — Tailored to Each Patient

Dr. Mislav Malić is a complete otologist who commands the full spectrum of surgical techniques — from endoscopic to complex microsurgical procedures of the temporal bone and skull base. He prefers the endoscopic approach because in appropriate cases it delivers better results with less trauma, but the choice of technique is always dictated by the disease, not by philosophy. Each patient receives the method that is optimal for them — not the one that is merely available.

Endoscopic Technique

Ideal for confined cholesteatomas in the middle ear, particularly in the anterior and inferior parts of the tympanic cavity. The procedure is performed entirely through the ear canal, without incisions and without bone drilling.

Combined Technique

Simultaneous use of endoscope and microscope for optimal results in more complex cases — combining the advantages of both methods.

Microsurgical Technique

For extensive cholesteatomas invading the mastoid and other areas. In cases of very advanced disease, we also perform complex microsurgical operations with obliteration and reconstruction of the ear.

The choice of surgical technique depends on: the size and extent of the cholesteatoma, the localisation of pathology, previous operations, the patient's anatomical specifics and the hearing status before surgery.

Postoperative Follow-up

Recovery and Follow-up

After cholesteatoma surgery, regular follow-up is mandatory regardless of the surgical technique. Postoperative recovery usually includes the use of antibiotics to prevent infection, keeping the ear dry and regular check-ups to monitor for recurrence of the cholesteatoma. Endoscopic control enables early detection of possible recurrence and timely intervention.

Recovery after endoscopic surgery is usually faster, with less postoperative pain and a shorter period required for full rehabilitation. In some cases, patients may experience temporary hearing loss or dizziness after surgery, but this generally improves over time. Hearing improvement depends on the extent of the disease and the possibility of reconstructing the ossicular chain.

I remember one patient who was astonished to learn that he could go home on the same day after surgery — knowing that when he had his first operation years earlier, he had to spend seven days in hospital. That is the difference that endoscopic surgery brings.

Specialist

Dr. Mislav Malić

Specialist in Otorhinolaryngology and Head and Neck Surgery · FEBORL-HNS · Doctor of Science

Dr. Mislav Malić is the pioneer of endoscopic ear surgery in Croatia. In 2018 he introduced this technique into clinical practice in the country and has since performed over a thousand endoscopic procedures. He organises international courses in endoscopic ear surgery and is a highly regarded invited speaker at professional conferences at home and abroad. Cholesteatoma surgery is one of his subspecialties — with the endoscopic approach he reaches parts of the tympanic cavity that are practically invisible in classical microsurgery.

More about Dr. Malić →

Cholesteatoma Surgery