What is a Cholesteatoma?

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  • Written By: Mary McMahon
  • Edited By: O. Wallace
  • Last Modified Date: 11 September 2019
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Cholesteatoma is a cyst in the middle ear which can have very serious complications. While the cyst may remain low level in some patients, without any long term consequences, in others it can lead to issues such as hearing loss, meningitis, or a brain abscess. Given these serious complications, it's important to treat a cholesteatoma when it is identified as a potential threat.

There are a number of circumstances under which a cholesteatoma can form. Some are congenital, while others form as a result of chronic ear infections. In all cases, the cyst includes dead skin cells and chunks of cholesterol which cannot drain from the ear. It may become infected with bacteria, causing a strong-smelling discharge. The patient also experiences soreness and pain in the ear, and may experience some hearing loss.

The immediate treatment for cholesteatoma is a clean out of the ear, in which a doctor goes in to flush out infected and dead material. In some cases, this may be sufficient to address the problem; sometimes the cyst just needs a little help draining and clearing. In other instances, surgery may be required to actually remove the cyst. During surgery, the area can also be assessed for any signs of long term damage.


Surgery may not always be recommended. The need for surgery depends on the patient and the situation, and a doctor will not recommend it if it is not necessary. Patients who aren't sure about the need for surgery can pursue an appointment with an ear, nose, and throat specialist for a second evaluation.

The issue with a cholesteatoma is that if the infection is allowed to persist, it can start eating into the bones of the ear, disrupting the complicated and delicate system used for hearing. The infection can also migrate into the brain, which is, as one might imagine, highly undesirable. While the brain is normally adroit at protecting itself from infection with the use of barrier materials, when infection does reach the brain, it can cause serious damage.

This condition can be diagnosed with an ear exam in which a doctor examines the ear visually. The cholesteatoma can be seen inside the ear, and the doctor can also take a swab so that the contents of the ear can be cultured. Certain types of bacteria are especially fond of hanging out inside cholesteatomas, and their presence can be a red flag which indicates that a cholesteatoma is present in the ear.


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