These neoplasms are benign or nonmalignant growths involving the outer, middle or inner ear. The most common benign neoplasm of the middle ear is the cholesteatoma, a cell-lined pocket or cyst-like sac filled with keratin debris that has the potential for local expansion and lysis.

The cause of most benign ear neoplasms is unknown. Cholesteatoma are the result of a cystic, inflammatory process that is filled with a combination of cholesterol and epithelial cells. They range in size from small to large lesions that may involve the middle ear or mastoid air cells. Complex proteins that enhance chemical changes (enzymes) form in the sac and cause erosion and destruction of adjacent bones.

Signs and symptoms of the condition may include obvious external and middle ear lesions, hearing loss, tinnitus, unsteadiness, vertigo (see Diagnostic Code: 6204 Peripheral vestibular disorders), otorrhea, perforation, headache, earache; dizziness, facial palsy or weakness.

Tests that may be used include: comprehensive physical examination; otoscopy; audiometry; magnetic resonance imaging (MRI); computed tomography (CT) scan; x-rays; biopsy; electronystagmography (ENG); and caloric stimulation test.

Surgical excision is the treatment of choice. It may range from radical mastoidectomy to tympanomastoidectomy. The latter may include ossiculoplasty to restore hearing.

Residuals may include: varying degrees of loss of hearing, vertigo, tinnitus and facial weakness/palsy.

• Rate on impairment of function. (38 CFR 4.87 [Schedule of ratings-ear])
• Compensation is payable for the combinations of service-connected and nonservice-connected disabilities specified in 38 CFR 3.383(a)(3) (see below) as if both disabilities were service-connected, provided the nonservice-connected disability is not the result of the veteran's own willful misconduct.
• Hearing impairment in one ear compensable to a degree of 10 percent or more as a result of service-connected disability and hearing impairment as a result of nonservice-connected disability that meets the provisions of 38 CFR 3.385 in the other ear.

Notes

• None.