Cholesteatoma is a collection of dead skin cells (also known as keratin) that sheds from the outer layer of the eardrum. The cells can get trapped behind the eardrum and cause cyst-like pockets to evolve and accumulate. If not treated, these pockets can be dangerous and even erode the hearing bones, the inner ear balance system and spread into the mastoid bone.

Cholesteatoma typically occurs when the eardrum is damaged from multiple infections, prior surgery or chronic negative pressure pulling the eardrum inward (the feeling of needing to pop your ears). Though rare, congenital cholesteatomas can also occur in adults and children without a history of ear problems, but skin got trapped behind the eardrum during development. 

Diagnosing Cholesteatoma

In the early stages of cholesteatoma, it can be easy to miss the signs, but as it progresses, you may start experiencing symptoms similar to a chronic ear infection; pain, ear drainage, hearing loss and even dizziness or vertigo. If you have one or more of these signs, contact your physician as soon as possible. As this disease worsens, you are at risk for an abscess or even meningitis because it can spread to areas around the lining of the brain. 

To diagnose cholesteatoma we begin with a careful ear examination, often done under the microscope, and a hearing test (audiogram) to document any associated hearing loss.

Typically, we will order a computed tomograpy (CT) scan to characterize the extent of your condition, and once we understand the severity of your cholesteatomas, we can create your treatment plan.

Treatment for Cholesteatoma

No cholesteatoma is the same, so we will take a personalized approach to treatment for each patient. Your treatment plan may includes both medical and surgical therapies to deliver the best results for your specific condition.

Medical Care

Because cholesteatomas do not dissolve, our goal is to treat the inflammation in your ear and decrease pain by thoroughly cleaning the ear, applying topical antibiotic drops and, if needed, oral medication.

For some small/limited cholesteatomas, they may be amenable to periodic cleaning in the office, if the patient can tolerate this and the disease is not extensive. 

Surgical Procedures

For patients with advanced cholesteatoma(s), surgery is the best treatment to remove the disease and ensure your ear stays safe and dry. This surgery is often a two-step process to ensure the best results. First, we remove the cholesteatoma and any additional disease in the ear, performing a mastoidectomy (removal of bone behind the ear canal) and tympanoplasty (eardrum repair). Several months later, after the ear is healed, we do a “second-look” to make sure that no additional disease remands behind the eardrum, and at this time, we may perform ossicular chain reconstruction to repair any damaged hearing bones from the prior surgery. Surgery for cholesteatoma is highly-individualized and the procedures/timing will vary for each patient.

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