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What is Cholesteatoma?

A cholesteatoma is a skin cyst behind your eardrum. It is not cancerous but requires early treatment to prevent severe conditions like permanent hearing loss, infection, vertigo, or nerve damage. The condition affects children and adults and usually occurs in only one ear but can involve both.

Cholesteatoma Symptoms

You may not have symptoms at first, but they can develop as the cyst grows. Ear drainage or hearing loss that do not get better with medical treatment are often the first signs.

As the growth gets bigger, it may become infected or grow into the bone around the ear. These complications can cause a number of symptoms:

  • Altered sense of taste
  • Dizziness
  • Hearing loss in one ear
  • Increased drainage that can look like pus or blood
  • Inflammation
  • Facial weakness
  • Pain, pressure, or full feeling in your ear
  • Tinnitus (ringing in your ears)

Cholesteatoma Discharge

Ear discharge associated with a cholesteatoma varies. It may be bloody, white or yellow, pus-like, or have a foul odor.

Can a Cholesteatoma Cause Headaches?

A cholesteatoma may cause headaches in advanced cases, but it’s not a common symptom. 

Cholesteatoma Causes

A problem with your Eustachian tube is the primary cause of cholesteatoma. Your eustachian tube connects your middle ear to your nasal-sinus cavity (hollow cavities behind your eyes, nose, and cheeks) and helps to balance the pressure in your ear.

If your ear’s pressure becomes unbalanced, the eardrum can “retract” and create a pocket that traps dead skin cells. Over time, the dead cells form a cyst that expands to cause damage. 

Some babies are born with cholesteatomas, but it’s rare.

Why Choose University of Utah Health?

A cholesteatoma will continue to grow and harm other tissue close to your ear. Without treatment, the cyst poses serious health problems like meningitis, brain infections, and facial paralysis.

Our multidisciplinary team offers the best chance of preserving your hearing and avoiding regrowth. At U of U Health, you have access to an expert team:

Find an Otolaryngologist Near You

Cholesteatoma Diagnosis

Doctors may suspect you have a cholesteatoma if you have the following symptoms:

  • Ear discharge
  • Gradual hearing loss
  • A history of ear infections and fluid build-up in the ear

Your provider will look in your ear and see the cyst or signs of a chronic infection. To confirm the diagnosis or rule out other reasons for your symptoms, your provider may recommend a computed tomography (CT) scan. You will also have a hearing test to assess the extent of your hearing loss.

Cholesteatoma Surgery

Surgery is the only way to remove a cholesteatoma. However, you may also need to take antibiotics to treat any infection. Surgery aims to remove the cholesteatoma, reconstruct the eardrum, and address your hearing. Your surgeon may perform any of the following procedures during the same surgery.

  • A mastoidectomy allows your surgeon access to the middle ear and mastoid to remove the cyst.
  • A tympanoplasty fixes damage to your eardrum and bones of hearing. Surgeons may use tissues from other parts of your ear to close holes in the eardrum.
  • An ossiculoplasty replaces bones eroded by the cholesteatoma with a prosthesis (artificial body part).

Cholesteatoma Removal: What to Expect

You’ll be asleep during the procedure. Your surgeon will first make a cut in the crease behind your ear. Then they will use a microscope to examine your eardrum and middle ear. Your surgeon will proceed to remove the cholesteatoma, reconstruct the ear and hearing mechanism, and close the incision (cut) with stitches.

How Long Does a Cholesteatoma Surgery Take?

Most surgeries take three to four hours. However, the procedure could take longer if the cholesteatoma has damaged your bones or surrounding tissues.

After Cholesteatoma Surgery: What to Expect

Most people go home on the same day as their surgery. When you leave the hospital, you’ll have cotton or gauze in your ear canal. Your surgeon will tell you when to take it out. You may feel dizzy for a few days, and your ear may feel stuffy or blocked. These side effects will improve as your ear heals.

You’ll also need to avoid some activities for a few weeks:

  • Air travel
  • Strenuous activities
  • Swimming or getting your ears wet

Your surgeon will provide complete instructions for aftercare.

Cholesteatoma Surgery Scar

External scarring from this surgery is minimal. Your ear and hair will cover most of the scar, making it virtually undetectable.

Cholesteatoma Recovery

Recovery from surgery takes about a week. After recovery, your care team will check your hearing to measure any improvement or determine if you need additional treatment.

It’s important to keep follow-up appointments with your provider after you’ve completely healed since cholesteatomas can regrow years following surgery.

Can a Cholesteatoma Grow Back?

Cholesteatomas grow back 5–10% of the time. In these cases, a second surgery is necessary to remove the cyst and prevent it from happening again.

When to See an ENT Specialist

An otolaryngologist or ENT is a doctor who cares for your ears, nose, and throat. These doctors assess and diagnose cholesteatomas. However, only a neurotologist has specialized training to perform these delicate cholesteatoma surgeries. If you have been diagnosed with a cholesteatoma or have symptoms that don’t go away, seek specialty care from a neurotologist.

Refer a Patient for Evaluation

If you've been recently diagnosed with a cholesteatoma, your primary care provider or other specialist will need to refer you to one of our ENT providers for further evaluation and testing.

To make an appointment, please call 801-587-8368 or request an appointment. Use our form to refer a patient to our ENT service.