Cholesteatoma: Causes, Symptoms, Complications, Diagnosis, Treatment, Prevention and Outlook

It is an abnormal, non-cancerous growth of the skin that can develop in the middle section of the ear, behind the eardrum.

It can be a birth defect, but it is most commonly caused by repeated middle ear infections. A cholesteatoma often develops as a cyst, or sac, shedding layers of old skin.

As these dead skin cells build up, the growth can enlarge and destroy the delicate bones of the middle ear. This can affect hearing, balance, and facial muscle function.

What Causes a Cholesteatoma?

In addition to repeated infections, a cholesteatoma can also be caused by a malfunctioning Eustachian tube , which is the tube that runs from the back of the nose to the middle of the ear.

The Eustachian tube allows air to flow through the ear and equalize the pressure of the ear. It may not work properly due to:

  • Chronic ear infections.
  • Sinus infections
  • Colds
  • Allergies

If your Eustachian tube is not working properly, a partial aspiration can occur in your middle ear.

This can cause a section of your eardrum to slide into the middle ear, creating a cyst that can develop into a cholesteatoma.

The growth becomes larger as it fills with old skin cells, fluids, and other waste materials.

Cholesteatoma in children

In very rare cases, a baby can be born with a cholesteatoma. This is considered a birth defect.

Congenital cholesteatomas can form in the middle ear or other areas of the ear.

In cases where children repeatedly acquire ear infections early in life, cholesteatomas may develop from a young age.

What are the symptoms?

Symptoms associated with a cholesteatoma usually begin mildly. They become more severe as the cyst grows and begins to cause problems inside your ear.

Initially, the affected ear may drain a foul-smelling fluid. As the cyst grows, it will begin to create a feeling of pressure in the ear, which can cause some discomfort.

You may also feel severe pain in or behind your ear. Pressure from the growing cyst can even cause hearing loss in the affected ear. Call your doctor immediately if you have any of these symptoms.

The dizziness , the paralysis of the facial muscle and permanent hearing loss may occur if the cyst continues to grow unchecked.

What are the possible complications of a cholesteatoma?

When left untreated, a cholesteatoma will grow and cause complications that range from mild to very serious.

Dead skin cells that accumulate in the ear provide an ideal environment for bacteria and fungi to thrive.

This means that the cyst can become infected, causing ongoing inflammation and drainage from the ear.

Over time, a cholesteatoma can also destroy the surrounding bone. It can damage the eardrum, bones inside the ear, bones near the brain, and nerves in the face. Permanent hearing loss can occur if the bones inside the ear break.

The cyst can even spread to the face if it continues to grow, causing facial weakness.

Other possible complications include:

  • Chronic ear infection.
  • Swelling of the inner ear
  • Paralysis of the facial muscles.
  • Meningitis, which is a life-threatening brain infection.
  • Brain abscesses or collections of pus in the brain.

How is it diagnosed?

To determine if you have cholesteatoma, your doctor will examine the inside of your ear with an otoscope.

This medical device allows your doctor to see if there are signs of a growing cyst. Specifically, they will look for a visible deposit of skin cells or a large mass of blood vessels in the ear.

Your doctor may need to order a CT scan if there are no obvious signs of cholesteatoma.

A CT scan may also be ordered if you show certain symptoms, such as dizziness and facial muscle weakness.

A CT scan is a painless imaging test that captures images of a cross section of your body. The scan allows your doctor to see inside your ear and skull.

This can help them better visualize the cyst or rule out other possible causes of your symptoms.

How is a cholesteatoma treated?

In general, the only way to treat a cholesteatoma is to remove it surgically. The cyst must be removed to prevent complications that can occur if it grows larger.

Cholesteatomas do not go away naturally. They usually keep growing and cause additional problems.

Once a cholesteatoma has been diagnosed, a regimen of antibiotics, ear drops, and careful ear cleaning will most likely be prescribed to treat the infected cyst, reduce inflammation, and drain the ear.

Your healthcare provider will be able to better analyze the growth traits of the cyst and develop a plan for surgical removal.

In most cases, the surgery is an outpatient procedure. This means that you do not have to stay in the hospital after the procedure.

A hospital stay is only necessary if the cyst is very large or if you have a severe infection. The surgery is performed under general anesthesia.

After the initial surgery to remove the cyst, follow-up surgery is often necessary to reconstruct the damaged parts of the inner ear and make sure the cyst has been completely removed.

Once the cholesteatoma is removed, you will need to attend follow-up appointments to evaluate the results and ensure that the cyst has not returned.

If the cyst broke some bones in your ear, you will need a second surgery to repair them.

After surgery, some people experience temporary dizziness or taste abnormalities. These side effects almost always resolve within a few days.

Prevention tips

Congenital cholesteatomas cannot be prevented, but parents need to know the condition so they can be quickly identified and treated when they are present.

You can prevent cholesteatomas later in life by treating ear infections quickly and thoroughly. However, cysts can still occur.

It is important to treat cholesteatomas as early as possible to prevent complications. Call your doctor right away if you think you have a cholesteatoma.

Long-term outlook for people with cholesteatoma

The long-term outlook for people with cholesteatomas is generally good. Complications are rare if the cyst is detected and removed early.

If a cholesteatoma sac has become particularly large or complex before it is identified, there may be permanent hearing loss.

Imbalance and vertigo can also be the result of a large cholesteatoma that grows through sensitive nerves and delicate bones in the ear.

Even if it increases in size, the cyst can almost always be successfully removed with surgery.