Cholesteatoma

Cholesteatoma may sound unfamiliar, but it’s an important condition that affects many people. This abnormal growth of skin cells in the middle ear can lead to hearing loss, ear infections, and even serious complications if left untreated. What may start as a minor concern can escalate into permanent hearing loss and infections spreading to nearby structures. If you're curious to learn more about cholesteatoma, read on to explore its causes, symptoms, treatment options, and effective prevention strategies.

What is Cholesteatoma?

Cholesteatoma is characterized by the abnormal growth of skin cells in the middle ear and surrounding areas of the skull. It often develops as a result of chronic ear infections, Eustachian tube dysfunction, or congenital factors (present at birth). Cholesteatomas typically start as small pockets or cysts that trap skin and debris, which can grow over time if not addressed.

Causes of Cholesteatoma

Several factors can contribute to the development of cholesteatoma:


  1. Chronic Ear Infections: Frequent ear infections can cause the eardrum to retract, creating pockets that trap skin cells and debris. Over time, these pockets can develop into cholesteatomas.
  2. Eustachian Tube Dysfunction: The Eustachian tube helps equalize pressure in the ear. If it becomes blocked or doesn’t function properly, fluid may accumulate in the middle ear, leading to infection and the formation of cholesteatoma.
  3. Congenital Factors: Some individuals are born with cholesteatoma due to abnormal development of ear structures during fetal development.
  4. Trauma: Physical trauma to the ear, such as a head injury or perforated eardrum, may also lead to the development of cholesteatoma.
  5. Chronic Sinus Issues or Allergies: These conditions can contribute to ear problems that may promote the formation of cholesteatoma.

Symptoms of Cholesteatoma

The symptoms of cholesteatoma can vary depending on its size and extent of damage. Common symptoms include:


  • Hearing Loss: As the cholesteatoma grows, it can damage the bones in the middle ear, often leading to noticeable hearing loss.
  • Ear Discharge: A foul-smelling discharge from the affected ear is common. This discharge may be brown or yellowish and can occur intermittently or continuously.
  • Ear Pain or Discomfort: While not everyone experiences pain, some individuals may feel discomfort in the affected ear.
  • Tinnitus: Ringing or buzzing sounds in the ear may occur due to pressure changes or damage to inner ear structures.
  • Balance Issues: In some cases, cholesteatoma can affect balance due to its impact on the inner ear.
  • Facial Weakness: Although rare, advanced cases can damage nearby structures, including the facial nerve, leading to weakness or paralysis of facial muscles on one side.
  • Swelling Behind the Ear: Growth into surrounding tissues may cause noticeable swelling or a mass behind the ear.


If you experience any of these symptoms, especially persistent ear discharge or hearing loss, it's important to consult an ENT specialist for an accurate diagnosis and appropriate treatment. Early intervention can help prevent complications associated with cholesteatoma.

Treatment Options for Cholesteatoma

Addressing cholesteatoma generally involves both surgical and non-surgical approaches. The treatment options include:


  1. Surgery: The primary treatment for cholesteatoma is surgical intervention aimed at removing the abnormal growth and repairing any damage to ear structures. This may involve removing infected tissue and reconstructing the eardrum.
  2. Antibiotics: If there is an active infection, your doctor may prescribe antibiotics to manage it before considering surgery.
  3. Regular Monitoring: After treatment, regular follow-up appointments are essential to monitor for recurrence and ensure proper healing. If hearing loss occurs due to cholesteatoma, hearing aids can also be a helpful solution.

Potential Complications of Untreated Cholesteatoma

If left untreated, cholesteatoma can lead to serious complications:


  • Hearing Loss: Persistent cholesteatoma may cause irreversible damage to auditory structures.
  • Spread of Infection: Infections can spread to surrounding areas, including the brain, potentially leading to serious conditions such as meningitis or brain abscesses.
  • Facial Nerve Damage: Advanced cholesteatomas can affect the facial nerve, causing weakness or paralysis in facial muscles.

Prevention Strategies

While not all cases of cholesteatoma can be prevented, certain strategies can reduce your risk:


  • Manage Ear Infections: Seek prompt treatment for ear infections and follow your doctor’s recommendations for managing chronic issues.
  • Practice Good Ear Hygiene: Avoid inserting objects into your ears and keep them dry to prevent infections.
  • Consult an ENT Specialist: If you have a history of ear problems or are at higher risk for cholesteatoma (due to chronic otitis media), regular check-ups with an ENT specialist can help monitor your ear health.

 

By staying informed and taking proactive steps regarding your ear health, you can help protect yourself from this potentially debilitating condition.

Medical Reviewers

Last Review Date: October 2024

Content Reviewers:

  • Dr. Thomas Higgins, MD, MSPH