A cholesteatoma is a non-cancerous skin cyst that develops in the middle section of your ear. It may be congenital—meaning that you were born with it. It can also be caused by repeated ear infections.
Typically, the symptoms of a cholesteatoma start out mild. They become more severe as the cyst grows larger and begins to cause problems within your ear.
Initially, you may experience fluids draining from the ear accompanied by an unpleasant odor. As the cyst gets larger, it will begin to create a sense of pressure that you will feel as discomfort. You may also feel an aching pain in or behind your ear. The pressure of the growing cyst may also cause you to lose hearing in that ear.
If the cyst is allowed to grow unchecked, it may affect your face, causing muscle weakness or even paralysis. At this point, the cyst may also cause you to feel dizzy.
A cholesteatoma is most commonly caused by a poorly functioning eustachian tube—the tube that leads from the back of the nose to the middle of the ear, allowing air to flow and equalizing ear pressure. The eustachian tube may not work properly due to chronic ear infections, sinus infections, colds, or allergies.
When the eustachian tube is not doing its job correctly, a partial vacuum may occur in the middle ear. This can cause a section of your eardrum to be pulled into the middle ear, creating a pocket, or cyst, that grows larger as it fills with old skin cells, fluids, and other waste materials.
In very rare cases, an infant may be born with a cholesteatoma as a birth defect. Congenital cholesteatomas may occur in the middle ear or other areas of the ear.
If left untreated, a cholesteatoma will grow larger and cause complications that range from mild to very severe. The cyst may become infected, causing inflammation and continual ear drainage.
The dead skin cells that accumulate to form a cholesteatoma can lead to many other problems. Over time, a cholesteatoma destroys the bone near it, possibly damaging the eardrum, the bones inside the ear, the bones near the brain, and the nerves of the face. The dead skin cells also provide an environment for bacteria and fungus to thrive.
If the cyst grows larger, it may spread into the face—causing paralysis, muscle weakness, or dizziness. It can even grow into the brain and cause abscesses there. Hearing loss may result if the bones within the ear are broken.
Other complications may include:
- permanent hearing loss
- chronic infection of the ear
- ear drainage
- dizziness or vertigo
- swelling of the inner ear
- facial weakness or paralysis of the facial muscles
- infection around or inside the brain—called meningitis—which can be fatal
- brain abscess: the collection of pus and immune cells in the brain, usually caused by infection and almost always fatal if not treated
The diagnosis of a cholesteatoma will depend on your symptoms. If you feel pain, pressure, or have drainage or hearing loss in your ear, your doctor will examine the inside of your ear using an otoscope. This instrument allows the doctor to see if there is a visible deposit of skin cells or a mass of blood vessels that indicate a growing cyst. Your doctor may also be able to see if there is a hole in your eardrum caused by the suction that created the cyst.
If the cyst is not obvious, and if you have symptoms such as dizziness and facial muscle weakness, your doctor may need to order a computed tomography (CT) scan. This is a painless imaging test—similar to an X-ray—that captures images from a cross-section of your body. The scan allows your doctor to see inside your ear and skull to better visualize the cyst or to rule out other possible causes of your symptoms.
The only way to treat a cholesteatoma is to have it surgically removed. The cyst must be removed to prevent the complications that can occur if it grows larger. Cholesteatomas do not go away naturally. They almost always grow larger and cause further problems.
In most cases, the surgery is an outpatient procedure. This means that you will not have to stay in the hospital afterward. A hospital stay is only necessary if the cyst is very large or if you also have a serious infection. Once the cholesteatoma is removed, you will need a follow-up visit with the surgeon to ensure that the cyst was entirely removed. If the cyst broke your ear bones, you will need a second surgery to repair them.
In some cases of cholesteatoma removal, an open cavity is created where the cyst was. You may need occasional office visits to have this cavity cleaned by your doctor to prevent infections.
Congenital cholesteatomas cannot be prevented. You can prevent cholesteatomas later in life by treating ear infections quickly and thoroughly. However, cysts may still occur. It is important to treat cholesteatomas early to prevent complications.
The long-term outlook for cholesteatomas is generally good. Typically, complications are minimal if the cyst is caught and removed early. Even if it does grow large, the cyst can almost always be removed successfully with surgery. Follow-up surgeries and doctor visits for reconstruction and cleaning may still be required after the initial procedure.