A cholesteatoma is an abnormal skin cell growth found in the middle ear, behind the ear drum. It can cause a smelly discharge from the ear, hearing loss and tinnitus (ringing in the ear). 

What causes cholesteatoma?

The cholesteatoma may have been present at birth (congenital). Doctors believe that during development in the womb, some skin cells develop in the wrong place within the ear. Cholesteatoma may also develop following repeated ear infections, causing skin cells to build up by the ear drum.

What are the signs and symptoms of cholesteatoma?

Common signs and symptoms of cholesteatoma include a smelly discharge from the ear, hearing loss and tinnitus (ringing in the ear).

If a cholesteatoma is not treated, it could continue to build up, causing damage to the inner ear. Structures inside the ear, such as the tiny ossicles, mastoid (bone behind the ear) and the cochlea (inner ear) may be damaged causing dizziness, balance problems and possibly permanent hearing loss.

Cholesteatomas are often infected – the main sign of infection is a smelly discharge. The infection can spread from the ear to the area of the skull near the ear, causing life-threatening conditions including meningitis (inflammation of the brain covering) and brain abscesses.

How is cholesteatoma diagnosed?

Doctors can diagnose a cholesteatoma using an otoscope – this is a tool containing a light and a magnifying glass that allows doctors to see into the canal. As well as seeing the cholesteatoma, they may be able to see a hole in the ear drum (perforation).

How is cholesteatoma treated?

There are two options for treatment. Usually, the first course of treatment involves a course of antibiotics and ear drops. Doctors may also suggest an operation to remove the cholesteatoma and any damaged tissue. This is a short operation carried out while the child is under general anaesthetic.

How can cholesteatoma be prevented?

A cholesteatoma cannot be prevented, although treating any ear infections promptly can be helpful. If the child has repeated ear infections, a doctor might suggest a series of tests and investigations to discover the cause.

What happens next?

A cholesteatoma can come back, even if it has been removed in an operation.

Compiled by: 
The Ear, Nose and Throat Department in collaboration with the Child and Family Information Group
Last review date: 
November 2015