Cholesteatoma

What is a cholesteatoma?
A cholesteatoma is a skin growth that occurs in an abnormal location: the middle ear behind the eardrum. It is usually caused by repeated infection that causes an ingrowth of the skin of the eardrum. Cholesteatomas often take the form of a cyst or pouch that sheds layers of old skin that builds up inside the ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear. Hearing loss, dizziness, and facial muscle paralysis are rare but can result from continued cholesteatoma growth.

How does it occur?
A cholesteatoma usually occurs because of poor eustachian tube function as well as infection in the middle ear. A rare congenital form of cholesteatoma (one present at birth) can occur in the middle ear and elsewhere, such as in the nearby skull bones. However, the type of cholesteatoma associated with ear infections is most common.

What are the 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.

Treatment
An examination by an otolaryngologist—head and neck surgeon can confirm the presence of a cholesteatoma. Initial treatment may consist of a careful cleaning of the ear, antibiotics, and eardrops. Therapy aims to stop drainage in the ear by controlling the infection. Large or complicated cholesteatomas usually require surgical treatment to protect the patient from serious complications.

From a brochure published by the American Academy of Otolaryngology—Head and Neck Surgery (1995); VEDA publication F-14, Cholesteatoma: A Serious Ear Condition.