Routine appointment leads to uncommon diagnosis

Corinne Breidung suspected her son Brett’s well-child exam would be as uneventful as his previous exams. But then Brett’s provider in Wabasha, Sharon Riester, Family Medicine nurse practitioner, said words no parent ever wants to hear.

“Something doesn't look right.”

Riester had spotted an abnormality in Brett’s ear. She contacted her colleague, Brian Coyle, M.D., an ear, nose and throat specialist who sees patients in Cannon Falls, Red Wing and Wabasha.

Dr. Coyle had seen Brett for hearing loss and had placed tubes in his ears a few years before; Riester thought he should examine Brett again. 

“The old ear tube was still in place when I examined him in the clinic, which partially limited my visualization,” says Dr. Coyle. “It was apparent that he had some significant retraction of his eardrum, but it wasn't until the old ear tube was removed during routine surgery that the extent became apparent. The retraction had pulled skin tissue from the outside of the eardrum to behind the eardrum, which creates a cholesteatoma.” This rare growth of skin tissue can eventually wear away at the bones of the ear. If untreated it can cause hearing loss, facial nerve weakness or paralysis. This retraction can occasionally happen in children with a history of ear infections.

Because the condition is so rare, Dr. Coyle referred Brett to Charles Beatty, M.D., an ear, nose and throat specialist at Mayo Clinic, for treatment.

“Cholesteatoma isn’t something we see very often locally,” says Dr. Coyle. “I wanted to make sure Brett saw a surgeon with experience treating the condition.”

Brett had surgery on June 18, 2013. Breidung says the wait during the four-and-a-half hour procedure was “extremely nerve wracking.” But when it was over, Dr. Beatty had good news: The cholesteatoma was caught early, and he had been able to remove the growth from bones it was touching. 

While the surgery was difficult for his mother, recovery proved hardest for Brett. The active 5-year-old had to give his ear time to heal. That meant a summer without baseball, swimming or jumping on the trampoline. 

“It was hard for Brett, but he knew what he had to do for his ear to heal,” says Breidung.

And the wait was worth it. Last fall Brett passed a hearing screening for the first time. Breidung is grateful for the team that worked together to make sure her son got exactly the care he needed.

“Sharon probably saved Brett’s hearing by speaking up about something that didn't look right to her,” says Breidung. “Dr. Coyle recognized the cholesteatoma as something that needed more specialized expertise and referred us to Rochester. And Dr. Beatty was able to remove the growth and repair Brett’s eardrum.”

And though they work in different locations, Breidung says Brett’s care felt coordinated and connected. 

“Each provider seemed to be caught up on Brett’s case,” says Breidung. “They really seemed to work as a team. Everything went smoothly for us. We received wonderful care at all three sites.”