The eustachian tube ventilates the hollow middle ear by connecting it to the back of the nasal cavity on each side. When the eustachian tube malfunctions such that it is fully or partially occluded, two things can happen: fluid can fill the middle ear and mastoid cavities or the eardrum can retract either broadly or focally.
This retraction occurs due to a negative pressure within the middle ear because the eustachian tube is not ventilating or equalizing pressure properly between the nose and ear. Accumulated fluid can cause hearing loss and can also become infected. Focal tympanic membrane retractions can form destructive cysts called cholesteatomas.
Cholesteatomas relentlessly grow, destroying the bone in its path ultimately threatening hearing loss, vertigo, facial paralysis and meningitis. In patients with cholesteatomas, surgery is required to make the ear safe and can allow hearing to be regained. Microsurgical skills, surgical creativity and determined intent are necessary to allow eradication of the cholesteatoma and to restore hearing and quality of life.
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