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Cholesteatoma: Causes, Symptoms, Diagnosis and Treatment

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A cholesteatoma is an abnormal, noncancerous growth that forms behind the eardrum or from the eardrum. It’s like a cyst that contains skin cells and connective tissue. Without treatment, the mass continues growing. Some cholesteatomas become large. In rare cases, they cause permanent hearing loss and other serious complications.


Who do cholesteatomas affect?

They affect adults and children. You may face a higher risk if you experience:

  • Recurring ear infections.
  • A ruptured eardrum, a small tear in the eardrum.

What causes an ear cholesteatoma?

There are many types, each with a different cause, including:

  • Primary acquired cholesteatoma: Occurs when the ear doesn’t drain or doesn’t even equal out pressure properly (eustachian tube). This improper drainage and pressure pulls the eardrum into the middle ear, allowing cells to collect.
  • Secondary acquired cholesteatoma: Develops when skin cells collect behind the eardrum after a rupture.
  • Congenital cholesteatoma: Forms when skin cells become trapped in the middle ear before birth.

What are cholesteatoma symptoms?

Early-stage cholesteatomas might not cause symptoms. Children might not experience symptoms other than hearing loss or recurrent ear infections. In both children and adults, one of the first signs can be discharge.

The discharge may be:

  • Dark.
  • Foul-smelling.
  • Pus-like.
  • Like earwax.
  • Sticky.

As the cyst grows, it can become infected, causing more drainage and inflammation. You may also experience:

  • Altered sense of smell and foods not tasting as they should.
  • Dizziness.
  • Pain.
  • Pressure or a feeling of fullness in your ear.

When should I see a healthcare provider?

If you have foul-smelling drainage from your ear and it doesn’t go away after two weeks, you should get an evaluation.

How is a cholesteatoma diagnosed?

The healthcare provider asks about your symptoms and health history. They examine the ear with a handheld device (otoscope). The otoscope helps the provider detect abnormal discharge or a white mass.

If you have signs of an ear cholesteatoma, additional testing may be necessary. You will likely receive a referral to a specialist.

What types of testing might I need?

An ear, nose and throat specialist (otolaryngologist) performs an advanced evaluation. This may include:

  • Tests to check for hearing loss.
  • Audiogram to assess your eardrum, middle ear and hearing.
  • CT scan of the ear, which helps see if there is damage to the ear bones.
  • MRI if there is a concern that the cholesteatoma is spreading through the skull base.

How do healthcare providers treat ear cholesteatomas?

Cholesteatoma treatment almost always needs surgery but to treat the concurrent infection, it may include:

  • Antibiotics to get rid of infections.
  • Ear drops to slow ear drainage.

Will I need surgery?

Almost all patients with cholesteatoma need surgery. You may need more than one procedure:

  • The initial surgery removes the cholesteatoma.
  • Additional cholesteatoma surgeries repair damage to the inner ear.

Is there anything I can do to prevent a cholesteatoma?

It’s not possible to prevent some cholesteatomas, especially if they are congenital. Timely ear care is key to avoiding primary or secondary acquired cholesteatoma. This includes getting an evaluation when there are concerns with simple infections or drainage that is not going away.

What is the outlook for people with ear cholesteatomas?

Cholesteatoma treatments often relieve discomfort and restore most of your hearing. Good results are more likely when a healthcare provider catches the cholesteatoma early. But it can come back, even if cholesteatoma surgery is successful. When a cholesteatoma comes back, hearing loss can worsen and you may need additional treatment.

What are the complications of large or complex cholesteatomas?

A cholesteatoma can damage the bones in your middle ear or cause inner ear damage if it’s extensive and spreads. You may experience:

  • Dizziness.
  • Hearing loss, which can sometimes come on suddenly.
  • Weakness in your facial muscles because of injury to the facial nerve.
  • Tinnitus.
  • Vestibular and balance disorders.

Severe but rare complications may include:

  • Brain abscess, pus and swelling in the brain.
  • Meningitis.

What can I expect after cholesteatoma treatment?

You will need monitoring from an ear, nose and throat specialist for a long time. Care may include:

  • Ear exams and hearing tests to check for signs of new ear cholesteatomas.
  • Ear washing (debridement) to remove skin cells and other tissue build-ups.

If the cholesteatoma comes back, you will likely need another surgery. It’s not uncommon for people to need many surgeries throughout their lifetime.

What’s daily life like after recovering from an ear cholesteatoma?

Most people go back to their daily activities. Some people have:

  • Anxiety that symptoms may come back, or fear of surgery (especially in children).
  • To avoid favorite activities, like swimming, for a few months.
  • Difficulty hearing and need special accommodations at work or school.
  • Balance issues that can take months to recover from.
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