Cholesteatoma

Definition

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

Causes, incidence, and risk factors

Cholesteatoma can be a birth defect (congenital), but it more commonly occurs as a complication of chronic ear infection.

Poor function in the eustachian tube leads to negative pressure in the middle ear. This pulls a part of the eardrum (tympanic membrane) the wrong way, creating a sac or cyst that fills with old skin cells and other waste material. The cyst becomes infected. The cyst may get bigger and break down some of the middle ear bones, affecting hearing.

Symptoms

• Dizziness
• Drainage from the ear
• Hearing loss in one ear
• Pain or numbness in or around the ear

Signs and tests

An ear exam 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, a special instrument to view the ear.

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

• Caloric stimulation
• CT scan
• Electronystagmography

Treatment

Surgery is needed to remove the cyst.

Expectations (prognosis)

Cholesteatomas usually continue to grow if not removed. Surgery usually works, but you may occasionally need the ear cleaned by a health care provider. Additional surgery may be needed if the cholesteatoma comes back.

Complications

• Brain abscess
• Deafness in one ear
• Dizziness (vertigo)
• Erosion into the facial nerve (causing facial paralysis)
• Labyrinthitis
• Meningitis
• Persistent ear drainage
• Spread of the cyst into the brain

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.

References

Smith JA, Danner CJ. Complications of chronic otitis media and cholesteatoma. Otolaryngol Clin North Am. 2006;39(6):1237-1255.