An uncommon middle ear condition characterized by a benign growth of skin cells.

A cholesteatoma is an uncommon middle ear condition characterized by a benign growth of skin cells. Though the tumor is noncancerous, it can cause damage to the surrounding tissues as it grows, leading to several complications, some more severe than others.


What Causes a Cholesteatoma?

While a cholesteatoma can be congenital (present as a birth defect), the most common cause is chronic ear infections. The eustachian tube is a channel between the middle ear and back of the nose, helping to equalize the pressure of the ear. During an ear infection, the eustachian tube can become blocked, resulting in a negative pressure gradient. This creates a vacuum-type situation that pulls at the eardrum. Eventually, this turns into a cyst, which accumulates dead skin cells, fluids, and other debris; this is then termed a cholesteatoma.

Other causes of eustachian tube dysfunction that can result in a cholesteatoma include sinus infections, colds, and allergies.

How Do I Know if I have a Cholesteatoma?

The early stages of a cholesteatoma tend to be associated with mild symptoms as the cyst is small. However, as it grows and begins to interfere with the surrounding structures, you may notice:

  • Foul-smelling discharge from the affected ear
  • A sense of increased pressure and discomfort within the ear
  • Hearing loss

Cholesteatomas tend to develop only on one side but having the condition in both ears is not unheard of.

A cholesteatoma that continues to grow without treatment can result in further, more severe symptoms. As the growth enlarges, it can damage the surrounding bones of the ear, the eardrum, and the nerve that controls the muscles of the face. If the cholesteatoma is not treated in time, you may experience other symptoms such as vertigo (dizziness), facial paralysis or weakness, and permanent hearing loss. The most severe complications of an untreated cholesteatoma are rare but can be devastating, including brain abscess (accumulation of infected pus in the brain) or meningitis (infection of the membranes surrounding the brain).

The diagnosis of a cholesteatoma can be performed by your family physician or an ENT (ear, nose, throat) specialist. By using a device designed to examine the ear called an otoscope, the doctor is able to assess the middle ear for signs of a cholesteatoma or cyst.

If the physical examination is inconclusive for a cholesteatoma, you may be referred for a CT scan to rule out other causes of your symptoms, particularly if you’re experiencing dizziness or weakness/paralysis of the facial muscles.

Treatment and Management of Cholesteatoma

Surgery is the only way to treat a cholesteatoma. This is performed under general anesthetic as a day procedure, meaning no overnight stay is typically necessary. As a cholesteatoma doesn’t resolve on its own and will continue to grow, it must be surgically removed in a timely manner to minimize the damage to nearby ear and brain structures.

Surgery for cholesteatoma is generally associated with good success, but as with any medical procedure, there is a risk of complications. These include:

  • Infection of the surgery site
  • Pain after the operation
  • Damage to the facial nerve
  • Hearing loss
  • Vertigo
  • Loss of taste
  • Scarring

If the cholesteatoma has already caused some disruption to other parts of the ear, such as nearby bones, you may need further operations to repair this. It is also possible for the cholesteatoma to recur in the future despite successful surgery to remove it initially. Such instances can be managed again with another operation as needed.