What is a Cholesteatoma?

A cholesteatoma is a skin cyst in the middle-ear made up of trapped skin cells and debris.  It is not cancerous, but it can cause destruction of the ear bones and tissues, and predispose to infections.


What causes Cholesteatoma?

There are several theories about cholesteatoma formation.  In some cases, children can be born with cholesteatoma where skin cells are abnormally trapped behind the ear drum.  In other cases, trauma or negative pressure can lead to the formation of a pocket in the eardrum that stores trapped skin and debris.  The trapped skin then continues to divide and grow, thus causing the cyst to grow. 


Why is it a concern?

Cholesteatomas damage the eardrum, and they can also grow. As they grow, they can damage the neighboring structures of the middle ear and even the inner ear and/or brain if left untreated. They can dramatically affect and damage hearing, cause dizziness, and injury to facial nerve. Cholesteatomas can also cause infections in the middle ear that, left untreated, sometimes spread to the brain.


How do we evaluate it?

Evaluation for a cholesteatoma involves an examination of the eardrum by an Ear Nose and Throat specialist (Otolaryngologist). It is useful to have a formal hearing test, to assess the impact on hearing.  Often, a CT scan, which uses a series of X-rays, is needed to further see the extent of the cholesteatoma. In certain cases, a special type of MRI scan called a diffusion weighted imaging MRI can also be helpful in detecting cholesteatoma.


How do we treat it?

Many cholesteatomas are removed with surgery, which is typically done under general anesthesia. This surgery removes the cholesteatoma from the eardrum and the space behind the eardrum, called the middle ear and mastoid.  At this time, the eardrum and hearing bones are often reconstructed.  Sometimes it can be very difficult to remove all of the skin cells of the cholesteatoma in one surgery, making it safer to separate the procedure into two or more surgeries.  

In some cases, cholesteatoma can be treated medically (without surgery) with periodic cleaning in the clinic.  This will depend on the extent of the cholesteatoma, and the patient's overall health status.


What is the long-term outlook of Cholesteatoma?

The long-term outlook for recovery is good. Hearing can be restored or aided with amplification after surgery depending on the extent of damage from the cholesteatoma. Infections can be treated with antibiotic ear drops or oral antibiotics as needed before and/or after surgery.

Cholesteatomas often start as a small skin cyst (Left) in the upper part of the eardrum, but with time can grow into the mastoid, the bony airspace behind the ear canal (Right), as well as lower to involve the hearing bones.