Cholesteatoma Causes, Symptoms, and Treatment

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A cholesteatoma is an abnormal, noncancerous skin growth in the middle ear, behind the eardrum. Unless treated, it can cause hearing loss as it continues to grow in size.

doctor examining senior patient's ear
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Causes of Cholesteatoma

A cholesteatoma can occur in any of several ways:

  • Cholesteatomas are most often caused by repeated middle-ear infections. If not treated, infection from a long-established cholesteatoma can spread to the inner ear and brain.
  • Some people are born with a small remnant of skin that is trapped in the middle ear, but this is rare.
  • A perforation of the eardrum (for example, from infection or trauma) can provide an opening for the skin of the eardrum's outer surface to grow through.
  • Chronic ear infections, sinus infections, allergies, and colds can affect the Eustachian tube (connecting the back of your nose to your middle ear), keeping it from doing its job of equalizing air pressure on either side of your eardrum. This can cause a partial vacuum in your middle ear that pulls a section of your eardrum into it. This eardrum tissue becomes a cholesteatoma.
  • As it grows larger, the cholesteatoma fills with sloughed-off skin cells, fluids, and other wastes, creating an ideal environment for infection. The growing cyst also increases pressure in your ear, which can cause hearing loss. If it grows very large, it can destroy surrounding bone, damaging your eardrum, the bones inside your ear and near your brain, and/or your facial nerves. At this stage, permanent hearing loss can occur.

What It Looks Like

A cholesteatoma resembles a pouch with layers of old skin. Quite a few websites have photographs of cholesteatomas (some are not for the squeamish). Here are two:

  • has photographs showing the formation of a cholesteatoma. The same site has photographs of surgery, including a picture of a large cholesteatoma that was removed.
  • Otolaryngology Houston has mastoid surgery pictures that include an example of a cholesteatoma that has worked its way up through the skin.


Depending on how long it's been present, symptoms of a cholesteatoma may include:

  • Hearing loss, which may be temporary (if treated early) or permanent
  • Ear pressure
  • Aching pain behind or in your ear
  • Vertigo (a sense of whirling around and loss of balance)
  • Drainage of a foul-smelling fluid
  • Facial muscle paralysis


A cholesteatoma must be treated to prevent or control deafness, meningitis, facial paralysis, bone loss, and other unwanted effects. More serious cholesteatomas are removed surgically, often through a mastoidectomy. Minor ones can be treated with professional ear cleaning and antibiotic treatment.

After treatment is complete, the patient must be monitored, because a cholesteatoma can recur.


Published books about cholesteatoma and treatments include:

  • Cholesteatoma: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References
  • Surgical Treatment of Middle Ear Cholesteatoma

Further research can be found in the National Library of Medicine's PubMed database.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Genetic and Rare Diseases Information Center. Cholesteatoma.

  2. Kuo CL, Shiao AS, Yung M, et al. Updates and knowledge gaps in cholesteatoma research. Biomed Res Int. 2015;2015:854024. doi:10.1155/2015/854024

  3. Choi JW, Park YH. Facial nerve paralysis in patients with chronic ear infections: surgical outcomes and radiologic analysis. Clin Exp Otorhinolaryngol. 2015;8(3):218-23. doi:10.3342/ceo.2015.8.3.218

  4. Vestibular Disorders Association. Cholesteatoma.

  5. UC Irvine Health Department of Otolaryngology. Ear infection or cholesteatoma?

By Jamie Berke
 Jamie Berke is a deafness and hard of hearing expert.