Cholesteatoma
An abnormal growth in the middle ear that can affect hearing and, if left untreated, damage nearby structures.
Quick Answer
A cholesteatoma is a noncancerous, abnormal growth of skin cells in the middle ear behind the eardrum. Although it is not cancer, it can continue to grow and damage nearby bone and structures involved in hearing and balance. In more advanced cases, it can extend toward the inner ear or skull base. Treatment typically involves surgery to remove the growth and prevent further damage or complications.
Key Takeaways
- A cholesteatoma is a noncancerous growth of skin cells behind the eardrum.
- Common symptoms include hearing loss, persistent ear drainage, pressure or fullness, and sometimes dizziness.
- Without treatment, the growth can damage the small bones of the ear and other nearby structures.
- CT imaging helps determine the size and extent of the cholesteatoma; MRI may be used in selected cases.
- Treatment typically involves surgical removal.
- Complex cholesteatomas extending toward the skull base may require coordinated care between ear and skull base specialists.
CHOLESTEATOMA AT A GLANCE
| What it is | A noncancerous growth of skin cells in the middle ear |
|---|---|
| Behavior | Can enlarge and damage nearby bone and structures |
| Common symptoms | Hearing loss, persistent ear drainage, pressure or fullness, and dizziness |
| Possible complications | Hearing damage, balance problems, facial nerve involvement, or extension toward the skull base |
| Diagnosis | Ear examination and CT; MRI in selected cases |
| Treatment | Surgical removal |
Symptoms
The most common symptoms are gradual hearing loss in the affected ear and persistent or recurrent ear drainage, which may have an odor. Some patients feel fullness or pressure in the ear. As a cholesteatoma enlarges and erodes bone, it can cause dizziness or, in advanced cases, facial weakness.
Because the growth expands slowly, symptoms often develop over time, and persistent ear drainage that does not resolve with usual treatment is a common reason for referral. Untreated, a cholesteatoma can lead to more serious complications.
Common Warning Signs
- Gradual hearing loss in one ear
- Persistent or recurrent ear drainage
- A foul odor from the ear
- Fullness or pressure in the ear
- Dizziness
When to Seek Care Promptly
- Facial weakness on the affected side
- Severe dizziness or vertigo
- Severe ear pain with fever
- Sudden hearing loss
- Signs of infection spreading beyond the ear
Diagnosis
A cholesteatoma is often identified during an ear examination, which can reveal the characteristic growth behind or involving the eardrum. Hearing tests document the degree of hearing loss. CT of the temporal bone is important to show the extent of the growth and any erosion of the surrounding bone.
MRI may be used in selected cases, particularly to assess extension toward the inner ear or skull base or to evaluate for residual or recurrent disease after surgery.
Treatment
Treatment for a cholesteatoma typically involves surgery because the growth does not resolve on its own and can continue to enlarge and damage surrounding structures. The goals of surgery are to completely remove the cholesteatoma, create a safe and healthy ear, prevent complications, and preserve or reconstruct hearing when possible.
The specific surgical approach depends on the size and location of the cholesteatoma and the structures it involves. Many cholesteatomas are managed by an ear specialist. When the growth is extensive, approaches the skull base, or involves critical structures such as the facial nerve, coordinated care with a skull base neurosurgeon may be appropriate.
At Atlantic Brain and Spine, complex cases involving the skull base can be evaluated collaboratively with the appropriate ear specialists to determine the safest surgical approach.
The Diagnosis-to-Treatment Pathway
1. Ear evaluation
Examination and hearing tests help identify the cholesteatoma and assess hearing loss.
2. Imaging
CT defines the extent of the growth and any bone erosion; MRI may be used in selected cases.
3. Assessment
The size, location, and involvement of nearby structures or the skull base are evaluated.
4. Surgical planning
The surgical approach is selected based on the extent of the cholesteatoma and the structures involved.
5. Removal
Surgery is performed to remove the cholesteatoma while protecting nearby critical structures.
6. Reconstruction
Hearing structures may be reconstructed when appropriate.
7. Follow-up
Ongoing examination and imaging when needed monitor for residual or recurrent cholesteatoma.
Frequently Asked Questions
It is an abnormal, skin-like growth rather than a cancerous tumor, but it behaves in a locally destructive way, gradually enlarging and eroding the surrounding bone. Because it does not resolve on its own and can cause complications, it requires treatment.
Cholesteatomas can develop from long-standing problems with ear ventilation and the eardrum, allowing skin cells to accumulate in the middle ear, or they can be present from birth. Over time the accumulated material forms a growth that expands and erodes nearby bone.
A cholesteatoma does not go away on its own and continues to grow, eroding bone and potentially causing hearing loss, dizziness, facial weakness, or spread toward the inner ear and skull base. Surgical removal eliminates the growth and prevents these complications.
Cholesteatomas commonly cause hearing loss by damaging the structures that conduct sound. Surgery removes the growth and, when possible, reconstructs the hearing mechanism. The degree of hearing recovery depends on how much damage occurred before treatment.
If left untreated, a cholesteatoma can enlarge and erode toward the inner ear or the skull base and nearby structures. In such cases, care may involve both ear specialists and the skull base team. Timely treatment reduces the chance of these complications.
Cholesteatomas can recur or leave residual disease, so follow-up examination and, in some cases, imaging are used to monitor after surgery. If residual or recurrent disease is found, further surgery may be needed. Complete removal reduces this risk.
Specialists Who Treat Cholesteatomas
Your care is provided by Atlantic Brain and Spine’s skull base specialists, working closely with ear specialists when needed.
Related Articles
View All Articles
An Unexpected Brain Tumor Diagnosis—and a Remarkable Recovery
After an unexpected meningioma diagnosis, Jim Van Arsdale turned to Yaron A. Moshel, MD, PhD, for brain tumor…
Still Running: How Brain Surgery Got a Glioblastoma Patient Back in the Race
At 77, Tom Brand was diagnosed with glioblastoma after losing his ability to speak. Following advanced brain surgery…
Brain Surgery Saved Her Life – Now She Saves Others as She Stands With Ukraine
After life-saving brain tumor surgery, Mariya Martynenko transformed her recovery into a mission—supporting Ukrainian refugees, veterans, and frontline…
It Takes a Team: How Collaborative Care Treated a Brain Tumor
When troubling symptoms turned out to be a brain tumor, Chris found expert, collaborative care at Atlantic Brain…
