Cholesteatoma is a serious and potentially destructive condition of the middle ear and mastoid. Despite its name, a cholesteatoma is not a true tumor or cancer. Rather, it is an abnormal collection of skin cells (squamous epithelium) that grows in the middle ear space behind the eardrum. Over time, this growth can enlarge and cause significant damage to the delicate structures of the ear, leading to hearing loss, infection, and balance problems.

What Causes a Cholesteatoma?

Cholesteatomas most often develop as a complication of chronic ear infections or poor eustachian tube function. When the eardrum is retracted or perforated, skin cells from the ear canal can migrate into the middle ear. These cells then accumulate and begin to form a cyst-like sac. As the sac grows, it produces enzymes that can erode bone and damage the ossicles (the tiny bones of hearing).

Common Symptoms and Signs

The symptoms of a cholesteatoma can be subtle at first but worsen over time. The most common symptom is a persistent, foul-smelling ear discharge that does not respond to standard treatment. Many patients also experience a feeling of fullness or pressure in the affected ear.

Hearing Loss

Conductive hearing loss is a hallmark of cholesteatoma. As the growth expands, it can block sound transmission or erode the ossicles, resulting in a significant reduction in hearing ability. If left untreated, the hearing loss can become permanent and may even progress to sensorineural hearing loss if the inner ear is affected.

Vertigo and Balance Issues

Vertigo is a common and alarming symptom when a cholesteatoma erodes into the inner ear structures, such as the semicircular canals. Patients may experience dizziness, a spinning sensation, or loss of balance. This can be accompanied by nausea and difficulty walking. Vertigo indicates that the cholesteatoma has become advanced and requires urgent medical attention.

Are Cholesteatomas Tumors?

Although the term "cholesteatoma" contains the suffix "-oma" (which often implies a tumor), these growths are not true tumors or cancers. They are benign, non-cancerous collections of skin cells. However, they are aggressive and behave like a slow-growing tumor in their ability to destroy bone and surrounding tissues. In very rare cases, a long-standing cholesteatoma can become malignant, but this is extremely uncommon.

Diagnosis and Treatment

A cholesteatoma is usually diagnosed by an ear, nose, and throat (ENT) specialist using an otoscope or microscope. A CT scan may be ordered to assess the extent of bone erosion and involvement of the inner ear or mastoid.

Surgery is the only treatment for cholesteatoma. The goal of surgery is to completely remove the growth while preserving hearing and balance function whenever possible. In some cases, reconstruction of the eardrum or ossicles may be performed. Prompt treatment is essential to prevent complications such as permanent hearing loss, facial nerve paralysis, vertigo, or intracranial infection.

When to Seek Immediate Help

If you experience persistent ear drainage, hearing loss, or vertigo—especially if you have a history of chronic ear infections—you should see an ENT specialist as soon as possible. Early detection is key to avoiding the devastating effects of a cholesteatoma.