A cholesteatoma is an uncommon abnormal collection of skin cells inside the ear.

Left untreated, it progresses to grow and damage the delicate structures deep inside the ear, such as the tiny bones or ossicles and organs essential for hearing and balance.

A cholesteatoma can lead to:

  •  ear infections, causing discharge from the ear
  • hearing loss, which can be permanent
  • vertigo (the perception of rotatory motion of the self or the world around)
  • tinnitus (hearing sounds coming from inside the body, rather than from an outside source)
  • damage to your facial nerve, causing hemifacial weakness

In very rare cases, the infection can spread into the inner ear and brain, leading to a brain abscess or meningitis.

What causes cholesteatomas?

A cholesteatoma can develop if part of the eardrum collapses due to problems in equalising the pressure across it.

This occurs when there is a dysfunction of the Eustachian tube. This is a thin tube that connects the middle ear to the nasopharynx. One of its main functions is to equalize the pressure within the ear.

Dead skin cells are normally passed out of the ear, but if the eardrum collapses, it may create a pocket where the dead skin cells can collect.

A cholesteatoma can also occur after the eardrum has been damaged through an injury or infection, or after any kind of ear surgery.

It is possible to be born with a cholesteatoma as a result of the structures within the ear developing abnormally, but this is rare.

What are the warning signs?

Usually only one ear is affected by a cholesteatoma. The two most common symptoms are:

  • persistent, often smelly, discharge from the affected ear
  • gradual loss of hearing in the affected ear

Some people may also experience some minor discomfort or a feeling of fullness in their ear.

Seeing your GP

If ear problems such as hearing loss or persistent discharge occurs, consultation with your doctor is recommended.

The diagnosis of cholesteatoma maybe done after otoscopy. The procedure involves visualization of the ear with an otoscope, a handheld instrument that projects a beam of light.

If a cholesteatoma is seen, referral to a ear, nose and throat (ENT) specialist is done for further evaluation and management.


Treating a cholesteatoma

To confirm the diagnosis of cholesteatoma, the ENT specialist will re-examine the ear and may carry out some hearing tests. A computerized tomography scan (CT scan) is done to evaluate the extent of damage caused by the lesion.


Surgery is done to remove the cholesteatoma, and is performed under general anesthesia. The surgeon makes an incision either behind or just in front and above your ear. As well as removing the dead skin cells, they may also need to remove some of the sponge-like mastoid bone (part of the skull behind your ear) and repair any hole in your eardrum.

After the surgery, the ear will be packed with a dressing which is left in place for a few weeks. Instruction regarding aftercare will be given.

The risks of surgery are similar to those of leaving the cholesteatoma untreated, such as hearing loss, tinnitus and vertigo, but generally the benefits of removing the cholesteatoma far outweigh the risks.

After surgery

Hospital admission is necessary at least overnight to monitor any immediate post-operative complications. The surgeon will advise you to have a week or two off work.

Self care advice

At home, make sure to keep the ear dry. Washing the hair may be done after a week provided that water does not get in the ear. This can be done by plugging the ear with a cotton wool with Vaseline. hen you get home, take care to keep the operated ear dry.

Swimming, strenuous activities and sports may need to be avoided for a few weeks. Check with the surgeon during follow-up visits regarding the resumption of these activities.

The surgeon may also advise avoiding flying for several weeks after surgery. Again, you can ask them about this at your follow-up appointment.

Follow-up appointments

If nonabsorbable sutures are used, the need to return for removal of stitches is usually after a week or two.

Most people have a follow-up appointment in a clinic within a few weeks of the operation, when any dressings in your ear will be removed.

A cholesteatoma recur, or may develop in the previously unaffected ear. Regular follow-up appointments are done to monitor any recurrence or growth.

Some people need a second operation after about a year to ensure that there are no fragments of cholesteatoma left behind.

When to seek medical advice

You should contact your GP or the ENT department of the hospital if you experience:

  • discharge or significant bleeding from your ear or wound
  • a high temperature (fever)
  • severe or increasing pain

These problems could be a sign of a complication, such as an infection.

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