Cholesteatoma: What it Is, Symptoms, Causes, and Treatments

Cholesteatoma is an illness that affects the ear. It isn't very common within the general public, but its treatment can be complicated and its symptoms serious if you don't act with haste.
Cholesteatoma: What it Is, Symptoms, Causes, and Treatments

Last update: 11 November, 2020

Cholesteatoma is where a part of the mucosa membrane of the middle ear becomes harmful. This part then becomes epithelial tissue and produces dead cells that are easily infected. In other words, it’s a cyst-shaped structure that occurs due to the development of squamous epithelium where mucosa should be found. It’s a benign disorder.

According to clinical studies, this illness causes irreversible hearing loss, bone damage, and other serious complications, due to its expansive nature. As such, despite the fact that it’s a rare disorder, detecting its symptoms quickly and efficiently is essential. In this article, we tell you everything you need to know about cholesteatoma.

About its distribution

There are many disorders that can cause ear pain. With that in mind, it’s important to know which demographic groups are most at risk from this illness. Cholesteatoma turns out to be one more source for such symptoms, but not the only one.

A study in the Journal of Otolaryngology and Head and Neck Surgery shows a series of data relating to the worldwide distribution. They are as follows:

  • In general terms, cholesteatoma is a rare condition. It affects people between 3 and 70 years old, with the average patient being 41.
  • The number of individuals that suffer from this illness in any given population is 3 for every 100,000 infants, and 9 for every 100,000 adults.
  • Although it’s not common, 10-20% of cases reoccur after treatment

As you can see, we’re talking about a rarely presented condition, but one that’s difficult to eradicate. To combat it, an early diagnosis is essential; as more time passes, the greater the cystic mass grows. This then jeopardizes the hearing ability and well-being of the patient.

Pain caused by cholesteatoma.
Cholesteatoma is an auditory disorder that specifically manifests in the external canal of the ear

What is it and what causes it?

As we’ve mentioned above, this condition consists of the formation of a non-neoplastic lesion, caused by the presence of keratinized squamous epithelium in an abnormal region. This can be found in the epitympanum, mastoids, and the cavity of the middle ear. According to the cited sources above, there are three known types of cholesteatoma.

  • Congenital: there are embryonic remains of skin situated in an otherwise healthy eardrum
  • Primary acquired: it originates due to pockets of tympanic retraction which, according to studies, are characteristic depressions in some parts of the eardrum, like in small patches.
  • Secondary acquired: this comes from a tympanic perforation due to an infectious process, generally during infancy. This lesion doesn’t heal adequately and, as such, causes a cyst-shaped manifestation.

The acquired types are considered a variety of chronic otitis media; the primary acquired variation is more common among the general population. It’s also necessary to clarify that the type of cholesteatoma is based on the affected area, according to the place in the ear canal that it occupies.


The United States’ National Library of Medicine clarifies that the symptoms of cholesteatoma can be diverse. The most common ones are:

  • Vertigo
  • A pus-filled secretion that can become chronic due to infectious processes manifesting inside the ear. This is sometimes accompanied by a ‘full’ sensation or pressure inside the brain
  • Hearing lossfor the reduction of the transmission of sound that occurs when the ear canal is blocked by the cyst
  • Paralysis of the facial nerve due to the compression of nearby structures as the cysts grow in size
  • Brain abscess or meningitis

It’s clear that this is a condition with somewhat serious symptoms, caused by the cyst’s growth over a period of time. This in turn leads to complications, like the rupture of some of the bones in the middle ear, or other auditory structures. However, it good to highlight that some patients experience the illness asymptomatically.

Treatment for cholesteatoma

The treatment for cholesteatoma is complex, but the extraction of all of the cystic mass is difficult. It’s as a result of that, that 10-20% of cases can re-manifest in due time. Therefore, patients require regular check ups.

The only known definitive treatment is surgery, since professionals search to extract the mass of tissue, sometimes even at the cost of removing the middle ear ossicular chain. It’s possible that through surgery, surgeons can replace the adjacent bones that were damaged by the cartilage and synthetic structures.

Cholesteatoma check.
The approach taken to combat cholesteatoma is complicated and complex; it requires surgery.

Cholesteatoma isn’t common, but be careful

As we have discussed in this article, cholesteatoma isn’t a common disorder and occurs in an atypical, but uniform, way across the population. As such, when facing loss of hearing or ear pain, this illness is one of the last we should consider.

Despite its strange nature, cholesteatoma can cause true damage to the patients’ hearing if not caught early. With that in mind, when experiencing any problems with your hearing it’s always best to consult with a medical professional.

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