Cholesteatoma is an abnormal skin growth in the middle ear space or mastoid bone that is non-cancerous. It can be present at birth or develop later due to repeated ear infections which cause negative pressure and inward pulling of the eardrum. Left untreated, cholesteatomas can grow large, cause hearing loss and facial paralysis, and potentially spread to the brain. Diagnosis involves examination of the ear and sometimes CT scans or audiology tests. Treatment is primarily surgical removal of the cholesteatoma and repair of any ear damage to preserve hearing.

1. What is Cholesteatoma?

2. Cholesteatoma is an abnormal growth of skin in the middle
ear space or in the mastoid bone behind the ear. The growth is
classified as benign (non-cancerous).

3. What causes cholesteatoma?
Cholesteatomas can be present at birth
(congenital) or form later in life (acquired).

4. Congenital Cholesteatoma
Congenital cholesteatomas are present at birth,
either in the middle ear space or the mastoid
bone located in the skull behind the ear. There is
no known cause of congenital cholesteatoma. It
is a developmental abnormality.

5. Acquired Cholesteatoma
• Cholesteatomas can form after repeated
eustachian tube dysfunction (ETD) or ear
infections.
• ETD causes negative pressure to build within the
middle ear space and the eardrum is pulled
inward.
• This inward pulling of the eardrum forms a pocket
or perforation in the eardrum.
• This pocket or perforation fills with dead skin cells
which builds up in the middle ear space.

6. Formation of acquired cholesteatoma
A cholesteatoma can continue to increase in size and affect the
bones of the middle ear.

7. Symptoms of cholesteatoma
• Hearing loss in the affected ear
• Discharge from the ear with or without an odor
• Tinnitus in the affected ear
• Dizziness and/or imbalance
• Fullness or pressure in the ear
• Facial weakness or paralysis
The most common symptoms of cholesteatoma include
hearing loss and drainage from the ear. In severe cases
where the cholesteatoma is affecting surrounding
structures, dizziness or facial weakness can occur.

8. Cholesteatoma hearing loss
• A cholesteatoma can
cause a conductive
hearing loss.
• The severity of the
hearing loss will depend
on the size of the
cholesteatoma and
whether it is affecting
the bones of the middle
ear (ossicles).

9. How is cholesteatoma diagnosed?
Physical examination of the ear with an
otoscope. The dead skin tissue can sometimes
be seen through the eardrum.
A CT Scan and Audiology evaluation may also
be necessary to determine the size and
extent of damage of the cholesteatoma.

10. How is cholesteatoma treated?
• Initial treatment involves a thorough cleaning
of the ear, antibiotics and ear drops to treat
any infection.
• Surgery is necessary to remove the
cholesteatoma from the middle ear or
mastoid bone and preserve hearing.

11. Surgical procedures for cholesteatoma
• Tympanoplasty: surgery used to remove the cholesteatoma
from behind the eardrum and repair the eardrum perforation by
placing a “patch” over the hole.
• Mastoidectomy: surgery to remove the cholesteatoma from
the mastoid bone.
• Tympanomastoidectomy: surgery that involves both the
eardrum/middle ear space and the mastoid space.
• Ossiculoplasty: repair or reconstruction of the 3 bones of the
middle ear (ossicles) that can be damaged by a cholesteatoma.

12. Can cholesteatoma cause lasting
problems?
• If left untreated, cholesteatomas can become
large and infected. It can spread to the inner
ear and brain. This can lead to permanent
hearing loss, dizziness, facial paralysis, brain
abscess, or meningitis.
• Surgery is most often successful at removing a
cholesteatoma, but additional surgery may be
necessary if the cholesteatoma returns.

13. Resources:
https://www.marshfieldclinic.org/specialties/ent/ent-cholesteatoma
https://www.entnet.org/content/cholesteatoma
http://www.nlm.nih.gov/medlineplus/ency/article/001050.htm