Cholesteatoma

Definition
Cholesteatoma is a type of cyst located in the middle ear.

Causes, incidence, and risk factors

Cholesteatoma can be a congenital (present at birth) defect, but it more commonly occurs as a complication of chronic ear infection. Long-term inflammation and malfunction of the eustachian tube leads to chronic negative pressure in the middle ear.

This pulls a portion of the eardrum (tympanic membrane) inward, creating a sac or cyst that fills with old skin cells and other debris. The cyst becomes chronically infected. The cyst typically continues to fill with debris over time and may erode the mastoid bone and the bones of the middle ear.

Symptoms

     
  • drainage from the ear, usually chronic  
  • hearing loss in one ear  
  • pain or numbness in the ear or around the ear  
  • dizziness

Signs and tests
Inspection of the ear may show a pocket or perforation (opening) in the eardrum, often with drainage. The deposit of old skin cells may be visible with an otoscope.

The following tests may be performed to rule out other causes of dizziness.

     
  • electronystagmography  
  • caloric stimulation

Your doctor may order a CT scan to further evaluate the problem.

Treatment
The only known treatment is surgical removal of the cholesteatoma. Surgery may involve the creation of a common area in the middle ear and mastoid bone that may need to be periodically cleaned by the surgeon.

Expectations (prognosis)
Cholesteatomas usually continue to grow if not removed. Surgical treatment is effective, but there may be a need for periodic cleaning or repeat surgery if the cholesteatoma recurs.

Complications

     
  • deafness in one ear  
  • dizziness (vertigo)  
  • persistent ear drainage  
  • erosion into the facial nerve (causing facial paralysis)  
  • spread of the cyst into the brain  
  • labyrinthitis  
  • meningitis  
  • brain abscess

Calling your health care provider
Call your health care provider if ear pain, drainage from the ear, or other symptoms occur or worsen, or if hearing loss occurs.

Prevention
Prompt and complete treatment of chronic ear infection may help to prevent some cases of cholesteatoma.

Johns Hopkins patient information

Last revised: December 7, 2012
by Sharon M. Smith, M.D.

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