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23.10.2013
If ear infections go untreated the infection (similar to pus) in the middle ear space can grow and grow until it bursts the eardrum, resulting in a draining ear.
Cholesteatoma and ear tubes: When a child has had tubes inserted, a small cut is made in the eardrum for the tube to fit into. Cholesteatoma prevention: The secondary effects of ear infection, including infection spreading into the mastoid (the bump behind your ear) and the development of cholesteatoma was once a leading cause of death in children. How our ears work: In order to understand what a conductive hearing loss is, it is important to know a little about how we hear. Experience a bit of hearing loss: Plug your ears with your index fingers to experience a conductive hearing loss.
You understand better if you can watch people as they speak, but this is hard as people turn their heads, move around, cover their faces with their hands, etc.
A child experiencing frequent ear infections will have hearing loss that can change from day to day. My thanks to Judith Blumsack, PhD, who collaborated with me during the development of this information.  Information in this article is not intended as medical advice.
Typically, it is a growth in the middle ear,  in just one ear but it is possible for it to affect both ears. The reason for this developmental abnormality is unknown however it is not believed to run in families (not a genetic disorder). This hole can be very ragged, with uneven edges that make it hard for the eardrum to heal smoothly.
Today’s modern medicine can identify cholesteatoma growths and treat them early thereby preventing the most serious hearing loss and other complications, but it is still necessary for the family or individual to seek treatment. Since the source of the problem in many cases is Eustachian tube dysfunction (ears don’t ‘pop’) in about ? – ? of cases the cholesteatoma comes back and additional surgery is needed. A conductive hearing loss happens when sound cannot successfully get from the air, through the outer and middle ear, to be able to be processed by the inner ear and then recognized by the brain. The picture of the parts of the ear will help you understand the chain of events that happens when we hear sound. There are many problems that can interfere with sound reaching the inner ear and cause a conductive hearing loss. The hearing loss can range from 15 dB up to 60 dB and typically affects low pitch sounds more than high pitch sounds, although all hearing is likely to be affected. When you pay more attention, the effort spent listening takes away from ‘instant understanding’ meaning figuring out what was said takes a bit more effort too, along with the effort to listen. Those who have active ear infection along with a cholesteatoma are likely to have some conductive hearing loss that is always there and more hearing loss that fluctuates as their ear problems get better or worse over time. A special teacher can make sure the classroom teacher understands how unilateral hearing loss affects classroom understanding and can identify the need for a classroom listening device, like a classroom amplification system or a personal FM system.  Your child will benefit from understanding the types of situations that are most challenging and hearing tactics or self-advocacy strategies he can use to ensure that he is able to get the same access to teacher instruction and peer communication as his classmates.


This growth can be present behind the eardrum at birth or it can develop later, sometimes as a complication of middle ear infections. Ear infections that can cause conductive hearing loss and ear drainage are very common, especially in young children.
Sometimes there are parts of the eardrum tissue that do not heal cleanly and these bits extend into the middle ear space, resulting in the risk for skin tissue to begin to grow in the middle ear, layer upon layer to develop a cholesteatoma. Children who get ear tubes early and  subsequent tubes inserted without delay when needed, are much less likely to develop a cholesteatoma. It may be necessary, after surgery, for the ear to be cleaned as needed by a health care professional. For example, if a person has a build-up of earwax in the ear channel that is enough to interfere with the sound reaching the eardrum, that person would have a conductive hearing loss. Even though you experience a hearing loss, you would likely ‘pass’ a typical hearing screening at a school or doctor’s office. This inconsistency in the ability to hear makes listening extra challenging and can contribute to children learning to ‘tune out’ when there is noise or someone is speaking at a distance. When children go to the doctor with draining ears, it is up to the physician to rule out that a rare and serious cholesteatoma is not the cause. When the throat is a bit swollen such as when you get a cold, the Eustachian tube doesn’t open as often as it should. When a person has had multiple burst eardrums the eardrum may end up with weak spots where these holes have healed. At roughly the center of the pinna is a channel (called the ear canal) into which the sound travels on its way to what is called the eardrum (also known as the tympanic membrane). If you hold down the tabs of your ears with your index fingers to close off your ear canals you will have caused a conductive hearing loss. With your ears plugged and your back turned, listen to someone talking from across the room with some noise like the TV on. Sometimes a cholesteatoma is right behind the eardrum or has grown through the eardrum and the physician can easily see it.
When the Eustachian tube cannot open, the eardrum is pulled inward into the middle ear space as the pressure increases. The eardrum vibrates when sound strikes it, causing a chain of extremely tiny bones (called ossicles) that are located on the other side of the eardrum to vibrate. A person born with a malformed ear in which the entrance to ear canal is closed off (atresia, microtia), would have a conductive hearing loss because the malformation would prevent sound from entering the ear normally. There are different options for hearing aids for people with conductive hearing loss and your audiologist can help you decide if a regular hearing aid, bone conduction hearing aid, or a bone-anchored hearing device would be most appropriate. Children are most successful when families are fully involved in advocating for their child’s needs with the school team and supporting his success at home.


It can also develop in the space in the upper part of the middle ear where the ossicles are, making it impossible to see. A weak spot on the eardrum is likely to retract farther, developing a pouch or sac that can enclose in upon itself and become the start of a cholesteatoma.
If the ossicles are malformed or damaged, such as what can happen if there is a cholesteatoma,  they wouldn’t transmit sound well from the middle ear to the inner ear causing a conductive hearing loss. Children with unilateral hearing loss are at 10 times the risk for problems in school (learning, social, behavior) compared to their classmates without hearing loss. If it grows large it can even dissolve through the bone separating the middle ear space and the brain.
In those cases, the only symptom may be increasing hearing loss as the ossicles are dissolved by the cholesteatoma (see conductive hearing loss, below). The vibration of the last ossicle in the chain causes a small membranous section of the bony inner ear (called the cochlea) to also vibrate.  This vibration causes vibration of fluid that is inside the inner ear, and the vibration stimulates delicate cells inside the cochlea to respond and in turn send a message to the brain that a sound has occurred. This article is specifically about two other causes of a conductive hearing loss: cholesteatoma and chronic middle ear infections. This surprises most people because they assume that if one ear hears normally that there will be no problem. Serious potential complications of cholesteatoma include hearing loss, brain abscess, dizziness, facial paralysis, meningitis, and spreading of the cyst into the brain.
Sometimes this fluid becomes infected by bacteria that have traveled from the throat up the Eustachian tube to the middle ear space. If a problem interferes with the sound vibrations reaching the inner ear, we say that there is a conductive hearing loss. Once the eardrum returns to a more normal position, even if there is fluid behind it, the earache gets better. Depending on the extent of the problem, a person with a conductive hearing loss might have difficulty hearing only soft sounds or the person have difficulty hearing typical conversation. You can hear but it is much harder to understand what is said where there is any background noise and it is very easy to miss subtle communication, like quiet comments or the sounds we make to let someone know that we are paying attention to what they are saying.
It isn’t surprising that some children think others are talking about them because they can tell there is a conversation but cannot clearly understand what it is about.



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