Cholesteatoma
Chronic ear infection - cholesteatoma; Chronic otitis media - cholesteatoma
Cholesteatoma is a type of skin cyst that is located in the middle ear and mastoid bone in the skull.
The tympanic membrane is also called the eardrum. It separates the outer ear from the middle ear. When soundwaves reach the tympanic membrane they cause it to vibrate. The vibrations are then transferred to the tiny bones in the middle ear. The middle ear bones then transfer the vibrating signals to the inner ear. The tympanic membrane is made up of a thin connective tissue membrane covered by skin on the outside and mucosa on the internal surface.
Causes
Cholesteatoma can be a birth defect (congenital). It more commonly occurs as a result of chronic ear infection.
The eustachian tube helps equalize pressure in the middle ear. When it is not working well, negative pressure can build up and pull part of the eardrum (tympanic membrane) inward. This creates a pocket or cyst that fills with old skin cells and other waste material.
The cyst may become infected or get bigger. This can cause the breakdown of some of the middle ear bones or other structures of the ear. This can affect hearing, balance, and possibly the function of the facial muscles.
Symptoms
Symptoms include:
- Dizziness
- Drainage from the ear, which can be chronic
- Hearing loss in one ear
- Sensation of ear fullness or pressure
Exams and Tests
An ear exam may show a pocket or opening (perforation) in the eardrum, often with drainage. A deposit of old skin cells may be seen with a microscope or an otoscope, which is a special instrument to view the ear. Sometimes a group of blood vessels may be seen in the ear.
The following tests may be performed to rule out other causes of dizziness:
- CT scan
- Electronystagmography
- MRI scan
Treatment
Cholesteatomas very often continue to grow if they are not removed. Surgery is most often successful. However, you may need the ear cleaned by a health care provider from time to time. Another surgery may be needed if the cholesteatoma comes back.
Possible Complications
Complications may include:
- Brain abscess (rare)
- Erosion into the facial nerve (causing facial paralysis)
- Meningitis
- Spread of the cyst into the brain
- Hearing loss
When to Contact a Medical Professional
Contact your provider if ear pain, drainage from the ear, or other symptoms occur or worsen, or if hearing loss occurs.
Prevention
Prompt and thorough treatment of chronic ear infection may help prevent cholesteatoma.
References
Player B. Otitis media. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 680.
Thompson LDR. Tumors of the ear. In: Fletcher CDM, ed. Diagnostic Histopathology of Tumors. 5th ed. Philadelphia, PA: Elsevier; 2021:chap 30.
Version Info
Last reviewed on: 5/2/2024
Reviewed by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
