Cholesteatoma is a type of skin cyst located in the middle ear (behind the eardrum) and skull bone (mastoid). Cholesteatomas can result in permanent moderate conductive hearing loss in children and adults. In some cases, they can become infected and spread infection into the inner ear or lining around the brain (meningitis).

Patients can be seen by Texas Children's experts in Ear Nose and Throat (Otolaryngology).

Causes & Risk Factors

While infants can be born with a cholesteatoma, it is more common to occur as a result of a chronic ear infection.

The Eustachian tube can have negative pressure in it which can pull a part of the eardrum into the middle ear. This can create a pocket or cyst that fills with old skin cells or other material. This cyst is called a cholesteatoma. This pocket or cyst can become infected leading to chronic ear drainage. Despite the sound of the name, it is not a tumorous growth.

Symptoms & Types

Symptoms of cholesteatoma may include:

  • Ear drainage (common)
  • Hearing loss (common)
  • Mastoiditis (an infection of the mastoid bone of the skull)
  • Dizziness (rather uncommon)
  • Facial paralysis (rare)

There are 3 types of cholesteatoma:

  • Congenital cholesteatoma which appears at birth
  • Primary acquired cholesteatoma which is caused by negative pressure in the eardrum that creates a pocket of air
  • Secondary acquired cholesteatoma which is caused by a trauma or perforation of the ear drum

Diagnosis & Tests

A diagnosis of  cholesteatoma can be made through a physical exam by a physician carefully looking into the ear. Hearing tests are usually performed to assess for an impact on hearing. A computed tomography (CT) scan is often needed to determine the extent of the disease as well.

Treatment & Care

Surgery is generally needed to remove the cyst. If it is not removed, the cyst will continue to grow.

If the cyst is not removed, it can sometimes cause additional complications, such as:

  • Brain abscess
  • Deafness in one ear
  • Dizziness
  • Continuous ear drainage
  • Ear infections
  • Spread of the cyst into facial nerves or the brain

Oral antibiotics are minimally helpful in treating the associated infection with cholesteatomas but do not treat or address the underlying cause. Therefore, surgery is almost always recommended to remove the cholesteatoma, and sometimes more than 1 procedure is required. Sometimes topical antibiotics (antibiotic ear drops) are given to help minimize the spread of the infection until the cyst can be removed.

Living & Managing

Once a cholesteatoma has been removed, the area needs to be regularly monitored by your ear doctor (otolaryngologist) for return of the cyst. A second surgery may be necessary at a later date to confirm complete removal has occurred and sometimes to place a prosthesis to improve or restore hearing. Skin cells from the cholesteatoma can return at a later date, so follow-up visits may be recommended annually.