Cholesteatoma

A cholesteatoma is an uncommon abnormal collection of skin cells inside your ear.

Left untreated, it can continue to grow and damage the delicate structures deep inside your ear, such as the tiny bones and organs essential for hearing and balance.

A cholesteatoma can lead to:

• an ear infection, causing discharge from the ear
• hearing loss, which can be permanent 
• vertigo (the sensation that you, or the world around you, is spinning)
• tinnitus (hearing sounds coming from inside the body, rather than from an outside source)
• damage to your facial nerve, causing weakness in half your face

In very rare cases, an infection can spread into the inner ear and brain, leading to a brain abscess or meningitis.

What are the warning signs?

Usually only one ear is affected by a cholesteatoma. The two most common symptoms are:

• persistent, often smelly, discharge from the affected ear
• gradual loss of hearing in the affected ear

Some people may also experience some minor discomfort or a feeling of fullness in their ear.

What causes cholesteatomas?

A cholesteatoma can develop if part of the eardrum collapses because of problems equalising the pressure across it.

This occurs when the Eustachian tube is not working properly. This is a thin tube that runs from the middle ear to the back of the nose. One of its main functions is to help maintain normal air pressure within the ear.

Dead skin cells are normally passed out of the ear, but if the eardrum collapses, it may create a pocket where the dead skin cells can collect.

A cholesteatoma can also occur after the eardrum has been damaged through an injury or infection, or after any kind of ear surgery.

It is possible to be born with a cholesteatoma as a result of the structures within the ear developing abnormally, but this is rare.

Seeing your GP

You should see your GP if you have problems with your hearing or persistent discharge from your ear.

Your GP may diagnose or suspect a cholesteatoma after examining your ear with an otoscope, an instrument with a light and magnifying glass that allows doctors to see inside your ear.

If it's possible you just have an ear infection, you may initially be given a course of antibiotics to see if your symptoms improve.

If your GP thinks you have a cholesteatoma, they will refer you to hospital so your ear can be examined by an ear, nose and throat (ENT) surgeon.

Treating a cholesteatoma

To confirm that you have a cholesteatoma, an ENT surgeon will re-examine your ear and may carry out some hearing tests. You may also have a computerised tomography (CT) scan to see which parts of your ear are affected.

Surgery

In most cases, a cholesteatoma will be removed during an operation performed under general anaesthetic.

The surgeon generally makes a cut either behind or just in front and above your ear. As well as removing the dead skin cells, they may also need to remove some of the sponge-like mastoid bone (part of the skull behind your ear) and repair any hole in your eardrum.

When the operation is complete, you ear may be packed with a dressing that will need to be removed a few weeks later. You will be advised about how to look after it in the meantime.

The risks of surgery are similar to those of leaving the cholesteatoma untreated, such as hearing loss, tinnitus and vertigo, but generally the benefits of removing the cholesteatoma far outweigh the risks. You should discuss the risks with your surgeon.

After surgery

You will often need to stay in hospital at least overnight after the operation, and you should plan to take a week or two off work. Your surgeon can advise you about this.

Self care advice

When you get home, take care to keep the operated ear dry. You should be able to wash your hair after a week, provided you do not get water inside the ear. This can be avoided by plugging the ear with cotton wool coated with Vaseline.

Swimming, strenuous activities and sports may need to be avoided for a few weeks. Check with your surgeon at your follow-up appointment when it is safe to resume these.

Your surgeon may also recommend avoiding flying for several weeks after surgery. Again, you can ask them about this at your follow-up appointment.

Follow-up appointments

If your stitches are not dissolvable, they may need to be removed by your practice nurse after a week or two.

Most people have a follow-up appointment in a clinic within a few weeks of the operation, when any dressings in your ear will be removed.

A cholesteatoma can come back, and one may develop in your other ear, so you will need to attend regular follow-up appointments to monitor this. 

Some people need a second operation after about a year to check there are no skin cells left behind.

When to seek medical advice

You should contact your GP or the ENT department of the hospital if you experience:

• discharge or significant bleeding from your ear or wound
• a high temperature (fever)
• severe or increasing pain

These problems could be a sign of a complication, such as an infection.