What is cholesteatoma?

Cholesteatoma refers to cyst-like skin growth (squamous epithelium) in the middle ear, which can cause chronic inflammation. Ultimately, it may destroy the ossicles (bones in the middle ear) and the petrous bone (part of the temporal bone). You may notice the following symptoms:

  • Hearing loss
  • Vertigo (dizziness and a loss of balance)
  • Noticeable fluid from the ear with a foul smell
  • Pain behind or in your ear over some time
  • Facial muscle paralysis, in rare cases

Types of Cholesteatoma

Congenital cholesteatoma

Congenital cholesteatoma is very rare and occurs when squamous epithelium cells are left behind in the middle ear during the development of the embryo. The tympanic membrane (eardrum) is still intact.

Primary acquired or retraction cholesteatoma

Primary acquired or retraction cholesteatoma occurs when part of the eardrum has retracted. It’s caused by a ventilation problem in the middle ear, often because of a malfunctioning Eustachian tube (that connects the upper throat to the middle ear). It leads to low pressure in the middle ear and consequently results in the creation of a so-called retraction pocket. This mostly happens in the smaller and softer part of the eardrum, called Shrapnell’s membrane. Squamous epithelium accumulates in this retraction pocket, and the patient can develop cholesteatoma in a few years.

Secondary acquired cholesteatoma

Secondary acquired cholesteatoma is caused by a defect in the eardrum, which allows the epithelium to penetrate the middle ear.

How is cholesteatoma diagnosed?

It’s important to contact an ear-nose-throat specialist or audiologist the moment you have symptoms. The longer you leave it, the more permanent the damage.


The typical findings here are a defected eardrum, white epithelium scales, and eventually bone erosion in the ear canal wall, close to the eardrum.

CT scan

This can determine the extent of bone destruction with more accuracy.

Hearing test

Typically, patients suffer from conductive hearing loss (a hearing disorder that only affects the outer ear). If the cholesteatoma is so far advanced that the inner ear is already affected, sensorineural hearing loss is present.


Complications occur either due to the inflammation or increased displacement by the cholesteatoma. For example, there may be a destruction of the ossicles. When sound can’t reach the inner ear correctly, it results in hearing impairment.

How is cholesteatoma treated?

If the ear becomes infected, it can be treated with antibiotics and topical treatments. Surgery is the best option to completely heal cholesteatoma and patients have a good chance of recovery. Abnormal tissue and the tympanic cavity will be removed in the first phase. In the second, usually another operation, the focus is on the hearing impairment. Generally, this is possible with a tympanoplasty, in which the eardrum and, if necessary, the ossicles, are restored.

If facial paralysis or nystagmus (eye twitch) occurs, surgery is imperative. Conservative, non-surgical treatment should only be used to prepare for essential surgery.

Cholesteatoma and hearing aids

Surgery may cause mild to moderate hearing loss. After surgery, it’s important to consult a specialist about further treatment, if necessary. Hearing aids are a great, non-invasive solution to hearing loss. Modern hearing aids are powerful and discreet, and fit to your specific needs.