Photo by Mark Thomas Acosta

What is a cholesteatoma?

Cholesteatoma is defined as a cyst located in the middle ear. Cholesteatoma can be a congenital defect, but it more commonly occurs as a complication of chronic ear infections. Long-term swelling and dysfunction of the eustachian tube can lead to chronic negative pressure in the middle ear. This negative pressure pulls a portion of the eardrum (tympanic membrane) inward, creating a sac or cyst. This cyst then fills with old skin cells and other debris, becoming chronically infected. The bone behind the ear is called the mastoid bone, and it connects to the middle ear. In a healthy ear, it is filled with air; however, in cholesteatoma, this area becomes filled with irritated mucous membranes and the cholesteatoma itself often grows into this bone. The cyst typically continues to expand and may even erode the mastoid bone and middle ear bones. Meningitis, dizziness, and facial muscle paralysis are rare but can result from continued cholesteatoma growth.

Signs and Symptoms

Initially, the ear may drain, sometimes with a foul odor. As the cholesteatoma pouch or sac enlarges, it can cause a full feeling or pressure in the ear, along with hearing loss. (An ache behind or in the ear, especially at night, may cause significant discomfort). Dizziness, or muscle weakness on one side of the face (the side of the infected ear) can also occur. Any, or all, of these symptoms are good reasons to seek medical evaluation. Cholesteatoma may be prevented by prompt treatment of ear infections.

Diagnosis

Inspection of the ear may show a pocket or perforation (opening) in the eardrum, often with drainage. The deposit of old skin cells may be visible.

Diagnostic Tests

Audiologic testing helps to determine the presence and extent of hearing loss. Tests may be performed to rule out other causes of dizziness. A CAT scan will guide the ear surgeon as to how far the cholesteatoma has grown and whether it has eroded into the inner ear or brain. The CAT scan will also indicate which bones of hearing have been eroded.

Treatment

The only known treatment for cholesteatoma is removal of the cyst. Cholesteatomas usually continue to grow if not removed. Surgical treatment is effective, but there may be a need for periodic cleaning or repeat surgery if the cholesteatoma recurs.

For more information on surgical treatment of cholesteatoma, please click the following link: Surgical Treatment of Ear Infection, Ear Perforation, and Cholesteatoma.

Complications as a Result of Surgery

Possible surgical complications include, but are not limited to: deafness in one ear, dizziness, persistent ear drainage, erosion into the facial nerve (causing facial paralysis), leakage of cerebral spinal fluid, labyrinthitis, vertigo, meningitis, and brain abscess.