Understanding Middle Ear Cholesteatoma and Its Effects on Hearing

Written by Medicover Team and Medically Reviewed by Dr Shashi Kiran Somala , ENT

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Middle ear cholesteatoma is an abnormal growth of skin cells within the middle ear or mastoid bone. Although it is not a cancerous tumor, it can gradually enlarge and damage the delicate structures of the ear, leading to hearing loss, recurrent infections, dizziness, and, if left untreated, serious complications. Early diagnosis and surgical treatment are essential to preserve hearing and prevent permanent damage.

What are the Types of Middle Ear Cholesteatoma?

Middle ear cholesteatoma is classified according to its origin and pattern of development.

Congenital Cholesteatoma: Present at birth due to trapped epithelial tissue behind an intact eardrum.
Acquired Primary Cholesteatoma: Develops from a retraction pocket in the eardrum, usually caused by chronic Eustachian tube dysfunction.
Acquired Secondary Cholesteatoma: Occurs after eardrum perforation, chronic ear infections, trauma, or previous ear surgery.

What are the Symptoms of Middle Ear Cholesteatoma?

Symptoms often develop gradually and worsen as the cholesteatoma enlarges.

Persistent or foul-smelling ear discharge.
Hearing loss.
Ear pain or discomfort.
Feeling of fullness or pressure in the ear.
Dizziness or balance problems.
Tinnitus (ringing or buzzing in the ear).
Recurrent ear infections.
In advanced cases, weakness of the facial muscles or severe headaches.

What Causes Middle Ear Cholesteatoma?

Middle ear cholesteatoma develops when skin cells accumulate within the middle ear, most commonly because of poor Eustachian tube function or chronic ear disease.

Chronic or recurrent middle ear infections.
Eustachian tube dysfunction.
Retraction pockets in the eardrum.
Previous ear surgery or ear trauma.
Congenital epithelial tissue trapped during fetal development.
Persistent eardrum perforation.

When Should You See a Doctor for Middle Ear Cholesteatoma?

Seek medical evaluation if you have persistent ear symptoms, especially recurrent discharge or hearing loss. Early treatment helps prevent damage to the middle ear and surrounding structures.

Persistent or foul-smelling ear discharge.
Hearing loss that worsens over time.
Recurring ear infections.
Persistent ear pain or pressure.
Dizziness or balance problems.
Facial weakness or severe headaches.

Middle ear cholesteatoma is primarily treated by an otolaryngologist (ENT specialist). Audiologists, radiologists, and hearing rehabilitation specialists may also be involved in diagnosis and long-term care.

Prompt specialist evaluation can help preserve hearing and reduce the risk of serious complications.

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How is Middle Ear Cholesteatoma Diagnosed?

Diagnosis is based on clinical examination and imaging studies to determine the extent of disease.

Detailed medical history and symptom assessment.
Ear examination using an otoscope or operating microscope.
Audiometric hearing tests.
Tympanometry to evaluate middle ear function.
CT scan of the temporal bone to assess the extent of disease and bone destruction.
MRI when complications or recurrent cholesteatoma are suspected.

What are the Treatment Options for Middle Ear Cholesteatoma?

Surgery is the primary treatment for middle ear cholesteatoma. The goals are complete removal of the cholesteatoma, prevention of recurrence, and preservation or restoration of hearing whenever possible.

Mastoidectomy: Removal of the cholesteatoma from the mastoid and middle ear.
Canal wall-up or canal wall-down surgery: Selected based on the extent of disease.
Tympanoplasty: Repair of the eardrum and reconstruction of the middle ear when appropriate.
Ossicular chain reconstruction: Repair or replacement of damaged hearing bones to improve hearing.
Antibiotics: Used to treat active ear infections before or after surgery when indicated.
Regular follow-up examinations: Essential to detect residual or recurrent cholesteatoma.

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What are the Complications of Middle Ear Cholesteatoma?

If left untreated, cholesteatoma can progressively destroy surrounding tissues and lead to serious complications.

Permanent hearing loss.
Damage to the ossicles (middle ear bones).
Facial nerve paralysis.
Chronic ear infections.
Labyrinthitis causing severe dizziness.
Mastoiditis.
Meningitis or brain abscess in rare, advanced cases.

How Can Middle Ear Cholesteatoma be Prevented?

Although congenital cholesteatoma cannot be prevented, prompt treatment of ear problems can reduce the risk of acquired cholesteatoma.

Treat middle ear infections promptly.
Manage Eustachian tube dysfunction appropriately.
Attend regular follow-up for chronic ear disease.
Seek medical attention for persistent ear discharge or hearing loss.
Protect the ears from injury and follow post-operative care instructions after ear surgery.