Cholesteatoma: Not just bad skin behind the eardrum.

Cholesteatoma can cause significant issues if left untreated. This condition occurs when skin grows in the middle ear, where it shouldn’t be. Though it might seem like just a small ball of skin, the impact it can have on hearing and overall ear health is serious.

What is cholesteatoma?

Cholesteatoma can be congenital (present from birth) or acquired later in life. Acquired cholesteatomas often result from chronic ear infections or long-term negative pressure behind the eardrum. Over time, this pressure draws part of the eardrum inward, creating a pocket where skin cells can accumulate. If these cells break through the pocket, they can form a cholesteatoma. In rare cases, skin cells might become trapped behind the eardrum during ear surgery.

Complications of untreated cholesteatoma

If untreated, cholesteatomas can grow and cause damage to the delicate bones in the middle ear. This may lead to conductive hearing loss (CHL), blocking/ dampening sound from passing efficiently to the inner ear. Additionally, cholesteatomas can lead to chronic ear infections and foul-smelling discharge. It can also cause sensorineural hearing loss (SNHL), which is permanent and results from damage to the inner ear’s hearing cells. Other complications include dizziness, facial nerve palsy, and more rare instances, erosion of the bone separating the middle ear from the brain.

The importance of early diagnosis and treatment

Early diagnosis is crucial for preventing severe complications. Cholesteatomas can be managed with surgery, which involves removing the growth and potentially restoring hearing. However, even after successful surgery, ongoing monitoring is necessary since cholesteatomas can return.

Preventative care and long term management

Preventing cholesteatoma formation largely revolves around managing chronic ear infections and ensuring proper follow-up care after any ear-related surgeries. Regular hearing tests, particularly for individuals prone to ear infections or those with a history of perforated eardrums, can help detect any changes early. ENT specialists often recommend routine check-ups to monitor ear health and prevent long-term complications. In cases of recurrent infections, early intervention can make a significant difference in maintaining healthy hearing and avoiding the need for more complex treatments. By prioritizing ear care and addressing symptoms as they arise, many of the complications associated with cholesteatoma can be minimized.

Post-surgery recovery and hearing rehabilitation

After a cholesteatoma removal surgery, recovery focuses on healing the ear and improving hearing function as much as possible. It’s common to experience a temporary hearing loss, discomfort, or dizziness immediately following the procedure. Patients are usually advised to keep their ear dry and avoid activities like swimming or flying for several weeks to prevent complications.

For those who have experienced conductive hearing loss due to damage to the middle ear bones - Audiologists may conduct a series of hearing tests to monitor progress and determine the best course of action for improving hearing. In cases of sensorineural hearing loss, options such as cochlear implants or other advanced hearing technologies might be explored.

Long-term follow-up is crucial to monitor for any signs of cholesteatoma recurrence and ensure optimal ear health. Regular appointments with both an ENT specialist and audiologist, combined with routine hearing assessments, are key to maintaining good hearing outcomes after treatment.

Last updated: 18 August 2025.