Cholesteatoma - How and Why


What is a cholesteatoma?

Attic perforation

Attic perforation + Cholesteatoma

Attic granulation

Attic granulation + Cholesteatoma

This is a skin (epithelial) growth that occurs in an abnormal location for example the middle ear behind the ear-drum. It is caused by repeated infection, which produces an in growth of the epithelium of the eardrum. Cholesteatoma take the form of a cyst or pouch, which sheds layer of old epithelium that builds up inside the ear. The cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear. Hearing loss, dizziness and facial muscle paralysis rarely occur, but it can result from continued cholesteatoma growth.

How does it occur?

A Cholesteatoma occurs because of poor Eustachian tube function as well as infection in the middle ear. The tube conveys air from the back of the nose into the middle ear to equalize ear pressure. When the tubes work poorly, due to allergy, common cold or sinusitis, the air in the middle ear is absorbed by the body and partial vacuum results in the ear. The vacuum pressure sucks in the pouch or sac by stretching the eardrum, especially areas weakened by previous infections. This sac often becomes a cholesteatoma. A rare congenital form of cholesteatoma (one present at birth) occurs in the middle ear or in the nearby skull bones. The type of cholesteatoma associated with ear infections is most common.

What are the symptoms?

  • First, the ear may drain, sometimes with a foul odor. As the cholesteatoma pouch sac enlarges, it can cause a feeling of fullness or pressure in the ear, along with hearing loss. (An ache behind or in the ear especially at night may cause significant discomfort).
  • Dizziness can occur or there may be muscle weakness of one side of the face (the side of the infected ear) also occurs.

Any or all of these symptoms are good reasons to seek medical evaluation.

Is it dangerous?

Yes, Ear cholesteatoma is dangerous and should never be ignored. Bone erosion can cause the infection to spread into the surrounding areas, including the inner ear and brain. If untreated, deafness, brain abscess, meningitis and rarely death can occur.

What treatment can be provided?

Post OP

Post OP

An examination by an otolaryngologist- head and neck surgeon confirms the presence of a cholesteatoma. The treatment may consist of meticulous cleaning of the ear, a course of antibiotics and ear-drops. Therapy aims to stop drainage in the ear by controlling the infection. The characteristics of a cholesteatoma must be evaluated.

untreated Cholesteatoma

Infective complications following untreated Cholesteatoma

Large or complicated cholesteatoma require surgical treatment to protect the patient from serious complications. Hearing and balance tests, x-rays of the mastoid (the skull bone next to ear) and CAT scans (3-D X-rays) of the mastoid may be necessary. These tests are performed to determine the hearing level remaining in the ear and the extent of destruction the cholesteatoma has caused.

Surgery is performed under general anesthesia in most cases. The primary purpose of the surgery is to remove the cholesteatoma and infection and to achieve an infection-free, dry ear. Hearing preservation or restoration is the second goal of the surgery. In cases of severe ear destruction, reconstruction may not be possible. Facial nerve repair or procedures to control dizziness is required. Reconstruction of the middle ear is not always possible at the first stage of operation. And therefore a second operation may be performed six or twelve months later. The second operation will attempt to restore hearing and at the same time to inspect the middle ear space and mastoid for residual cholesteatoma.

Destroyed bone following untreated Cholesteatoma. This character of the disease makes it dangerous and leads to intra cranial (brain) complications.

Admission to the hospital is usually done on the morning of surgery and if the surgery is performed early in the morning, discharge may be the same day. For some, an overnight stay is necessary. In some cases a serious infection, prolonged stay in the hospital for antibiotic treatment may be necessary. Time off from work is typically one or two weeks.Follow-up office visits after surgical treatment is necessary and important, because cholesteatoma sometimes reccurs. In cases where an open mastoidectomy cavity has been created, office visit is needed for every few months to clean out the mastoid cavity and prevent new infections. Some may require a life long periodic ear examinations.


This is a serious, but treatable ear condition, which can only be diagnosed by medical examination. Persisting earache, ear drainage, ear pressure, hearing loss, dizziness, or facial muscle weakness signals the need for evaluation by an ENT Surgeon.