Cholesteatoma
Chronic ear infection - cholesteatoma; Chronic otitis media - cholesteatomaCholesteatoma is a type of skin cyst that is located in the middle ear and mastoid bone in the skull.
Cyst
A cyst is a closed pocket or pouch of tissue. It can be filled with air, fluid, pus, or other material.
Causes
Cholesteatoma can be a birth defect (congenital). It more commonly occurs as a result of chronic ear infection.
Chronic ear infection
Chronic ear infection is fluid, swelling, or an infection behind the eardrum that does not go away or keeps coming back. It causes long-term or perm...
The eustachian tube helps equalize pressure in the middle ear. When it is not working well, negative pressure can build up and pull part of the eardrum (tympanic membrane) inward. This creates a pocket or cyst that fills with old skin cells and other waste material.
The cyst may become infected or get bigger. This can cause the breakdown of some of the middle ear bones or other structures of the ear. This can affect hearing, balance, and possibly the function of the facial muscles.
Symptoms
Symptoms include:
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Dizziness
Dizziness
Dizziness is a term that is often used to describe 2 different symptoms: lightheadedness and vertigo. Lightheadedness is a feeling that you might fai...
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Drainage from the ear, which can be chronic
Drainage from the ear
Ear discharge is drainage of blood, ear wax, pus, or fluid from the ear.
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Hearing loss in one ear
Hearing loss
Hearing loss is being partly or totally unable to hear sound in one or both ears.
ImageRead Article Now Book Mark Article - Sensation of ear fullness or pressure
Exams and Tests
An ear exam may show a pocket or opening (perforation) in the eardrum, often with drainage. A deposit of old skin cells may be seen with a microscope or an otoscope, which is a special instrument to view the ear. Sometimes a group of blood vessels may be seen in the ear.
The following tests may be performed to rule out other causes of dizziness:
- CT scan
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Electronystagmography
Electronystagmography
Electronystagmography is a test that looks at eye movements to see how well nerves in the brain are working. These nerves are:Vestibular nerve (eigh...
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Treatment
Cholesteatomas very often continue to grow if they are not removed. Surgery is most often successful. However, you may need the ear cleaned by a health care provider from time to time. Another surgery may be needed if the cholesteatoma comes back.
Possible Complications
Complications may include:
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Brain abscess (rare)
Brain abscess
A brain abscess is a collection of pus, immune cells, and other material in the brain, caused by a bacterial or fungal infection.
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Erosion into the facial nerve (causing facial paralysis)
Erosion
Erosion is a breakdown of the outer layers of the skin, usually because of a: CutScrapeInflammation
ImageRead Article Now Book Mark ArticleFacial paralysis
Facial paralysis means that a person is no longer able to move some or all of the muscles on one or both sides of the face.
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Meningitis
Meningitis
Meningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the meninges.
ImageRead Article Now Book Mark Article - Spread of the cyst into the brain
- Hearing loss
When to Contact a Medical Professional
Contact your provider if ear pain, drainage from the ear, or other symptoms occur or worsen, or if hearing loss occurs.
Prevention
Prompt and thorough treatment of chronic ear infection may help prevent cholesteatoma.
References
Player B. Otitis media. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 680.
Thompson LDR. Tumors of the ear. In: Fletcher CDM, ed. Diagnostic Histopathology of Tumors. 5th ed. Philadelphia, PA: Elsevier; 2021:chap 30.
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Tympanic membrane - illustration
The tympanic membrane is also called the eardrum. It separates the outer ear from the middle ear. When sound waves reach the tympanic membrane they cause it to vibrate. The vibrations are then transferred to the tiny bones in the middle ear. The middle ear bones then transfer the vibrating signals to the inner ear. The tympanic membrane is made up of a thin connective tissue membrane covered by skin on the outside and mucosa on the internal surface.
Tympanic membrane
illustration
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Tympanic membrane - illustration
The tympanic membrane is also called the eardrum. It separates the outer ear from the middle ear. When sound waves reach the tympanic membrane they cause it to vibrate. The vibrations are then transferred to the tiny bones in the middle ear. The middle ear bones then transfer the vibrating signals to the inner ear. The tympanic membrane is made up of a thin connective tissue membrane covered by skin on the outside and mucosa on the internal surface.
Tympanic membrane
illustration
Review Date: 5/2/2024
Reviewed By: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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