Cholesteatoma

What is cholesteatoma?

A cholesteatoma is an abnormal, non-cancerous accumulation of skin cells (keratin) in the middle ear. If left untreated, it can cause serious, permanent damage. As the dead skin cells build up, they can form a expanding cyst that gradually erodes and damages the surrounding delicate structures of the ear, including the middle ear bones (ossicles), the eardrum, and even the inner ear.

What Causes a Cholesteatoma?

A cholesteatoma can develop due to several factors, including:

• Eustachian Tube Dysfunction: If the Eustachian tube (which connects the middle ear to the back of the nose and throat) fails to function properly, a chronic vacuum (negative pressure) develops in the middle ear. This vacuum can pull a portion of the eardrum inward, creating a pocket where dead skin cells become trapped and accumulate.
• Chronic Ear Infections: Frequent, long-term, or poorly healed middle ear infections can facilitate the migration of skin cells into the middle ear.
• Congenital Cholesteatoma: In rare cases, children can be born with tiny remnants of skin cells trapped behind the eardrum, developing a cholesteatoma without any prior history of infections.
• Trauma or Previous Surgery: A physical injury to the eardrum (such as a perforation) or previous middle ear surgeries can occasionally allow skin cells to enter and grow inside the middle ear space.

Symptoms of a Cholesteatoma

A cholesteatoma typically develops very slowly and may be entirely asymptomatic in its early stages. As the growth expands, symptoms begin to surface and may include:

• Foul-Smelling Ear Discharge (Otorrhea): A persistent, often watery or pus-like fluid draining from the ear, which frequently has a noticeably unpleasant odor.
• Progressive Hearing Loss: Occurs as the growth dampens eardrum vibrations or physically erodes the delicate ossicular chain (hearing bones).
• A Sensation of Pressure: A constant feeling of fullness, stuffiness, or pressure deep within the affected ear.
• Ear Pain: Pain or deep discomfort in the ear, which is typically more pronounced if an active infection is present.
• Dizziness and Vertigo: If the cholesteatoma erodes into the inner ear (the labyrinth), it can disrupt your balance system, causing significant dizziness.

How is a Cholesteatoma Diagnosed?

If a cholesteatoma is suspected, a comprehensive evaluation by an ENT specialist is required. The diagnosis is made using:

• Otomicroscopy: The specialist will examine your ear canal and eardrum under a high-magnification surgical microscope. This allows them to clearly see any pocketing, crusting, discharge, or abnormal skin tissue behind the eardrum.
• Hearing Assessment: A complete hearing test (audiometry) is conducted to measure the impact of the growth on your hearing capability.

Imaging (CT or MRI Scans): A CT scan of the temporal bone is almost always performed to assess the exact size and extent of the cholesteatoma, and to determine whether it has begun to erode the surrounding bone, hearing bones, or inner ear structures. In some cases, a specialized MRI scan (non-EPI DWI MRI) is used to map the tissue..

Read also about:

Chronic otitis media

Drainage in the eardrum

Tinnitus

Fact box about cholesteatoma

Complications of cholesteatoma:

Without treatment, cholesteatoma can lead to serious complications, including:

Permanent hearing loss: Cholesteatoma can damage the small ear bones, which can lead to permanent hearing loss.

Infections: Cholesteatoma can cause chronic ear infections, which can spread to the surrounding tissues and lead to mastoiditis or, in rare cases, a brain abscess.

Dizziness and balance problems: If the cholesteatoma affects the inner ear, it can cause dizziness or problems with balance.

Destruction of ear bones: Cholesteatoma can damage the small bones of the middle ear, which may require complex reconstruction of these structures.

Long-term follow-up:



After cholesteatoma removal, regular follow-up is often required to ensure that the growth does not return and that any infections are treated promptly. Additional surgeries or treatments may be necessary to achieve the best possible hearing and prevent complications.

When should you contact the doctor?

You should contact your ear doctor if you:

• Experiencing persistent ear pain, even after treatment.
• Have persistent or worsening hearing loss.
• Notices ear discharge, especially if it is smelly.
• Experiencing balance problems or dizziness.

Cholesteatoma is a serious condition that requires attention and treatment to prevent complications such as hearing loss and infections. The most effective treatment is surgical removal offered at Charlottenlund Privathopolis by some of Denmark's most experienced ear surgeons.

If you have any questions about your treatment or diagnosis, you are always welcome to contact us.