Cholesteatoma

Cholesteatoma is a type of skin cyst that is located in the middle ear and mastoid bone in the skull.

Causes of Cholesteatoma

Cholesteatoma can be a birth defect (congenital). It more commonly occurs as a complication of chronic ear infection.

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.

Cholesteatoma Symptoms

• Dizziness
• Drainage from the ear
• Hearing loss in one ear

Tests and Exams

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 -- 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
• Electronystagmography

Treatment of Cholesteatoma

Surgery is needed to remove the cyst.

Prognosis (Outlook)

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.

Potential Complications

• Brain abscess
• Deafness in one ear
• Dizziness (vertigo)
• Erosion into the facial nerve (causing facial paralysis)
• Labyrinthitis
• Meningitis
• Persistent ear drainage
• Spread of the cyst into the brain

When to Contact a Health Professional

Call your health care provider if ear pain, drainage from the ear, or other symptoms occur or worsen, or if hearing loss occurs.

Prevention of Cholesteatoma

Prompt and thorough treatment of chronic ear infection may help prevent cholesteatoma.

References

Chole RA, Sudhoff HH. Chronic otitis media, mastoiditis, and petrositis. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Elsevier Mosby; 2010:chap 139.

O'Handley JG, Tobin EJ, Shah AR. Otorhinolaryngology. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 19.