Cholesteatoma: What It is, What Causes It, How It's Treated

Early Detection Is Key to Preventing Hearing Loss

doctor examining senior patient's ear
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A cholesteatoma is an abnormal, noncancerous skin growth in the middle ear, behind the eardrum. Unless treated, it can cause hearing loss as it continues to grow in size.

What Causes a Cholesteatoma?

A cholesteatoma can occur in any of several ways:

  • Some people are born with a small remnant of skin that is trapped in the middle ear, but this is rare.
  • A perforation of the eardrum (for example, from infection or trauma) can provide an opening for the skin of the eardrum's outer surface to grow through.
  • Chronic ear infections, sinus infections, allergies, and colds can affect the Eustachian tube (connecting the back of your nose to your middle ear), keeping it from doing its job of equalizing air pressure on either side of your eardrum. This can cause a partial vacuum in your middle ear that pulls a section of your eardrum into it. This eardrum tissue becomes a cholesteatoma.

    As it grows larger, the cholesteatoma fills with sloughed-off skin cells, fluids, and other wastes, creating an ideal environment for infection. The growing cyst also increases pressure in your ear, which can cause hearing loss. If it grows very large, it can destroy surrounding bone, damaging your eardrum, the bones inside your ear and near your brain, and/or your facial nerves. At this stage, permanent hearing loss can occur.

    What Does a Cholesteatoma Look Like?

    A cholesteatoma resembles a pouch with layers of old skin. Quite a few websites have photographs of cholesteatomas (some are not for the squeamish). Here are two:

    • - Includes photographs showing the formation of a cholesteatoma. The same site has photographs of surgery, including a picture of a large cholesteatoma that was removed.

    What Are the Symptoms of a Cholesteatoma?

    Depending on how long it's been present, symptoms of a cholesteatoma may include:

    • hearing loss, which may be temporary (if treated early) or permanent
    • Ear pressure
    • Aching pain behind or in your ear
    • Vertigo (a sense of whirling around and loss of balance)
    • Drainage of a foul-smelling fluid
    • Facial muscle paralysis

    How Can a Cholesteatoma Be Treated?

    A cholesteatoma must be treated to prevent or control deafness, meningitis, facial paralysis, bone loss, and other unwanted effects. More serious cholesteatomas are removed surgically, often through a mastoidectomy. Minor ones can be treated with professional ear cleaning and antibiotic treatment. After treatment is complete, the patient must be monitored, because a cholesteatoma can recur.

    Resources on Cholesteatoma

    Published books about cholesteatoma and treatments include:

    • Cholesteatoma - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References
    • Surgical Treatment of Middle Ear Cholesteatoma

    Further research can be found in the National Library of Medicine's PubMed database.

    Support for People with Cholesteatoma

    Yahoo Groups has a large and active support group, "Cholesteatoma."

    Learn From a Personal Experience With Cholesteatoma

    An Deafness/Hard-of-Hearing (HOH) visitor shared his personal experience with cholesteatoma:

    "I have been HOH since the age of 2 years. I began wearing hearing aids at age 9 years. I was prone to ear infections, and due to the birth anomaly -- cleft lip and palate -- my Eustachian tubes do not function properly. At age 23 years, I was diagnosed with cholesteatoma tumors in both ears.

    I had a 50/50 chance of going deaf or improving my hearing. I came out of my surgery being able to hear the crickets, birds singing, etc., to the point of having to wear huge padded ear muffs like they use on the gun range. The hearing lasted three months before returning to my previous level, with additional losses as time passed.

    I have had an additional nine surgeries for recurring tumors and to the present date I am planning another surgery soon for another. The last time I told the doctor I had another tumor, he looked in my ear and said there was none, but the Silastic sheet they placed in there the last time was poking through my eardrum and there was another hole besides. He mentioned surgery to remove that and repair the eardrum. I said, "Let's go, when can we do it." He was not in a hurry, but I knew better after having eight previous tumors.

    I went in the following week and when I came out of recovery, my only statement was, "Well, was there a tumor?" The doctors were embarrassed, but told me, "You scared the hell out of us, there was a tumor and it destroyed the stapes so we had to put a prosthetic stapes in place and we decided to try another form for the eardrum." They replaced the eardrum with a cartilage graft instead of the standard vein graft. What was to be an 1-1/2 hour surgery became five hours.

    Now doctors are listening to me when I say there is a tumor, as I have almost mastered the signs of their growth pattern. One thing is imperative: Anyone who has had these tumors...don't mess around, listen to your body. Demand to have CT or MRI scans every six months to a year regularly. My doctors have never ordered the scans because I am a Medicare/Medicaid client. They never told me about the process of watching and having routine scans to monitor the recurrence. I did research to find out what I know to this day and I demanded the scan and finally had one that revealed my present tumor, otherwise I would have been ignored and left to endure more deadly consequences.

    I am presently a candidate for the bone-anchored cochlear implant, but due to Medicare/Medicaid not understanding that the implant is a prosthetic device and not a true hearing aid, I do not receive the necessary hearing assistance to be a functional individual in our society.


    “Cholesteatoma.” HealthLine.Com (2016). 

    I am not able to wear conventional hearing aids due to the recurrent tumors and my allergy to the materials that earmolds are made of. So for those of you who have the symptoms listed in the article I am responding to, don't wait, demand the CT/MRI or wait to die a silent or harsher death by meningitis, etc. Take it from one who has been through 10 surgeries and waiting for No. 11.

    The cholesteatoma tumor is not an infection, it is the build up of squamous skin cells that pack into a mass.

    If you get an ear infection and bacteria gets embedded in the mass it will do more damage, as it is the bacteria that erodes the bone. If no bacteria gets in, then it just grows until it involves the other parts of the ear and creates symptoms requiring it to be removed. So take care of your ears and have them checked regularly as hearing is a precious gift from God.

    I will always carry the memories of crickets chirping and the birds singing, the rustle of leaves, and the first cry of newborn life (puppies, kittens, and a baby crow that fell from it nest and the adults would not allow me to help). For I know I will lose my hearing someday soon.


    A mother shared her child's experience:

    My son was constantly complaining of ear pain, I took him repeatedly to his primary care doctor and she would say over and over again for two years that he doesn't have an ear infection. She would tell me he has a lot of wax buildup in his ear.

    One time she had the nurse irrigate his ears saying it would clean out his ear -- it didn't. She told me to use liquid stool softener to keep the wax soft so it would drain. A nurse irrigating his ear at one visit poked his eardrum. After that it was very hard to get him to sit correctly and quietly to have his ears checked.

    I repeatedly asked for a referral to an ENT but she insisted he did not need an ENT.

    On one visit I took a sample of what came out of his ear -- it was clearly tissue, not wax. Yet again, I was told to keep using the stool softener. Finally on his next visit he had a new doctor. I explained my concerns to her and she looked at his chart. She gave us the referral on that first visit. So finally I thought we will get this taken care of.

    On the first appointment the doctor talked about a possible cholesteatoma. So then we went through five sets of tubes in his ear, tonsils and addenoids removed. Another two years passed and we got a referral...She scheduled hearing tests, and a CT scan. Finally a diagnosis and course of treatment -- he had a mastoidectomy with a tympanoplasty.

    He has hearing that comes and goes in that ear. He will have to have a second surgery to try and restore hearing. We now go three months between appointments instead of every month or more. Now if I could just get the school district to realize he has a physical disability, not a learning disability.

    Maybe they will supply the ALD that he needs to learn.

    Do you have or have you had, a cholesteatoma? Send your experience to Deafness/HOH for addition to this article.

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