A common birth defect, cholesteatoma is an abnormal, non-cancerous skin growth that develops in the middle section of the ear (behind the eardrum). In most cases, the condition involves a collection of dead skin cells that often develops as a cyst, or sac, that sheds layers of old skin. As the amount of dead skin cells continue to accumulate, the growth can increase in size and destroy the delicate bones of the middle ear. According to reports from MedicalNewsToday, cholesteatomas have an annual incidence of 9 -12.6 out of 100,000 adults and 3–15 out of 100,000 children (2020 statistics). These growths are found to be more common among boys than girls. Treatment usually involves surgery to remove the growth. If left untreated, the condition can significantly impair a person’s hearing and balance as well as the function of their facial muscles.

Otolaryngologists and other specialists who treat this condition need to correctly document the same in patient medical records. Opting for medical billing services from an established medical billing company can help simplify the documentation process.

Here are some frequently asked questions and answers about cholesteatoma –

What causes cholesteatoma?

Majority of cholesteatoma cases are acquired. Also called benign ear cyst, the condition usually occurs due to the poor functioning of the eustachian tube in combination with infection in the middle ear. When the eustachian tube does not work properly, pressure within the middle ear can pull part of the eardrum in the wrong direction. This in turn creates a sac or cyst that fills with old skin cells. As the cyst becomes bigger, parts of the middle ear bones may break down significantly affecting hearing. As more dead skin cells develop, the sac gradually expands and a cholesteatoma develops. In other cases, skin grows around the margin of a perforation onto the middle ear. Other related causes include – repeated ear infections, skull or facial bone birth abnormalities, dead skin cells and earwax (moving into the middle ear), sinus infections and an injury to the eardrum.

What are the signs and symptoms of a cholesteatoma?

Initially, the signs and symptoms of the condition start in a mild form. As the cyst or mass grows larger, it causes more problems within the ear. Early symptoms may include fluid drainage from the ear, sometimes with a foul odor. As the cyst grows bigger, it will begin to create a sense of pressure in the ear, causing serious discomfort. Patients may experience a feeling of aching pain in or behind the ear. In due course, the pressure of the growing cyst may even cause hearing loss in the affected ear. Other related symptoms include –

  • Loss of hearing (which tinnitus may complicate)
  • Pain in the ear
  • Frequent and recurring ear infections
  • Feeling of “fullness” in one ear
  • Facial muscles seeming weak on the side of the affected ear
  • Drainage from the ear, which often smells bad
  • Dizziness (or vertigo)
  • Constant sound inside your ear (tinnitus)
  • A sensation of ear fullness

How is cholesteatoma related to ear infections?

Patients who have had previous problems with middle ear fluid or infections are more likely to develop a cholesteatoma. However, it may be years before the cholesteatoma forms. An untreated cholesteatoma can be life-threatening in the long-term, causing serious complications like – permanent hearing loss, paralysis of facial muscles, ongoing problems with balance, meningitis, erosion of hearing bones, chronic ear infections and brain abscess.

What are the potential chances of getting a cholesteatoma?

It is not exactly clear how many people may develop cholesteatomas. However, it is a relatively common reason for ear surgery. The number of congenital cases is not known, but it is considered to be rarer than the non-congenital form.

How is a cholesteatoma diagnosed?

Diagnosis of a cholesteatoma begins with a physical examination and complete medical history evaluation. Otolaryngologists will examine the inside of the ear using an otoscope. An otoscope is a combination of a magnifying glass and a flashlight that allows physicians to see if there are signs of a growing cyst. Specifically, physicians will look for a visible deposit of skin cells or a large mass of blood vessels in the ear. Otolaryngologists may also recommend performing an audiogram (hearing and balance tests), X-rays of the mastoid (the skull bone next to the ear), and CAT scans of the mastoid to determine the hearing level remaining in the ear and the extent of destruction caused by the cholesteatoma.

How is a cholesteatoma treated and documented?

Treatment for a cholesteatoma aims to stop drainage in the ear by controlling the infection. Initial treatment for this condition may consist of a careful cleaning of the ear, antibiotics, and eardrops. The cyst must be removed to prevent the complications that can occur if it grows larger. Large or complicated cholesteatomas usually require surgical treatment to protect the patient from serious complications. Surgery is performed under general anesthesia in most cases. The primary purpose of the surgery is to remove the cholesteatoma and infection, and achieve an infection-free, dry ear. Hearing preservation or restoration is the second goal of surgery. In addition to removing the growth, surgery may be necessary to restore the eardrum, rebuild the hearing bones and remove bone defects from behind the ear. Once the cholesteatoma is removed, patients need to attend follow-up appointments to evaluate results and ensure that the cyst doesn’t come back. After performing the surgery, most patients experience temporary dizziness or taste abnormalities which may resolve within a few days. After undergoing the surgery, patients need to protect the surgical area by keeping the ears dry, avoiding strenuous activities for a few weeks, and avoiding swimming and air travel (for a few weeks) to make sure that the cholesteatoma does not return.

What ICD-10 codes are used for diagnosing cholesteatoma?

The correct medical codes must be used to document the diagnosis, screening and other procedures performed. Medical billing and coding services provided by reputable companies can help physicians use the correct codes on their medical claims. The following ICD-10 codes are relevant with regard to “cholesteatoma” –

  • H60.4 Cholesteatoma of external ear
    • H60.40 Cholesteatoma of external ear, unspecified ear
    • H60.41 Cholesteatoma of right external ear
    • H60.42 Cholesteatoma of left external ear
    • H60.43 Cholesteatoma of external ear, bilateral
  • H71 Cholesteatoma of middle ear
  • H71.0 Cholesteatoma of attic
    • H71.00 Cholesteatoma of attic, unspecified ear
    • H71.01 Cholesteatoma of attic, right ear
    • H71.02 Cholesteatoma of attic, left ear
    • H71.03 Cholesteatoma of attic, bilateral
  • H71.1 Cholesteatoma of tympanum
    • H71.10 Cholesteatoma of tympanum, unspecified ear
    • H71.11 Cholesteatoma of tympanum, right ear
    • H71.12 Cholesteatoma of tympanum, left ear
    • H71.13 Cholesteatoma of tympanum, bilateral
  • H71.2 Cholesteatoma of mastoid
    • H71.20 Cholesteatoma of mastoid, unspecified ear
    • H71.21 Cholesteatoma of mastoid, right ear
    • H71.22 Cholesteatoma of mastoid, left ear
    • H71.23 Cholesteatoma of mastoid, bilateral

What are the possible ways to prevent cholesteatoma?

In most cases, it is not possible to prevent congenital cholesteatomas. It is important for parents to remain fully aware about the specific condition so that it can be quickly identified and treated when present. For acquired cholesteatoma, properly treating ear infections is the best prevention strategy. However, cysts may still occur. It is important to treat cholesteatomas as early as possible to prevent complications in the long run.

What is the long-term outlook for people with cholesteatoma?

The long-term outlook for people with cholesteatoma is generally positive. Surgery is necessary to remove this benign mass before complications occur. Complications are rare if a surgeon removes the cholesteatoma at an early stage. Follow-ups are important after surgery as the cyst can at times re-grow after years.

Otolaryngology medical billing and coding can be challenging as it requires the right knowledge regarding the modifiers and payer-specific billing for correct and on-time reimbursement. With all the complexities involved, the support of a reliable and experienced medical coding service provider would prove useful to report cholesteatomas correctly.