Causes and Risks: Cholesteatoma may be a congenital defect but more commonly occurs as a complication of chronic ear infection. Prolonged inflammation and malfunction of the eustachian tube leads to chronic negative pressure in the middle ear. This pulls a portion of the eardrum (tympanic membrane) inward, creating a sac or cyst that fills with old skin cells. The cyst becomes chronically infected. The cyst typically continues to grow and may erode the mastoid bone and the bones of the middle ear.

Prevention: Prompt and complete treatment of chronic ear infection may help to prevent some cases of cholesteatoma.

Symptoms:

• drainage from the ear, usually chronic
• hearing loss in one ear
• pain or numbness in the ear or around the ear
• dizziness

Signs and Tests: Inspection of the ear may show a pocket or perforation (opening) in the eardrum, often with drainage. The deposit of old skin cells may be visible with an otoscope.

The following tests may be performed to rule out other causes of dizziness:

• electronystagmography
• caloric stimulation

Treatment: The only known treatment is surgical removal of the cholesteatoma. Surgery may involve the creation of a common area in the middle ear and mastoid bone that may be periodically cleaned by the surgeon.

Prognosis: Cholesteatomas usually continue to grow if not removed. Surgical treatment is effective, but there may be a need for periodic cleaning or repeat surgery if the cholesteatoma recurs.

Complications:

• deafness in one ear
• dizziness
• persistent ear drainage
• erosion into the facial nerve (causing facial paralysis)
• spread of the cyst into the brain
• labyrinthitis
• vertigo
• meningitis
• brain abscess

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