Cholesteatoma: Symptoms, Diagnosis and Why It Should Not Be Ignored

A cholesteatoma is an abnormal collection of skin cells within the middle ear or mastoid bone behind the ear. Although it is not a cancer, it can behave aggressively by slowly expanding and damaging the delicate structures of the ear.

Many patients first notice a persistent ear discharge, repeated infections, hearing loss, tinnitus, pressure in the ear or dizziness. Symptoms can be intermittent, which means the condition may be present for months or years before it is fully recognised.

At Hampshire ENT Clinics, patients with chronic ear discharge, recurrent ear infections, hearing loss, eardrum problems and suspected cholesteatoma can access consultant-led assessment across Hampshire, including Winchester, Portsmouth/Havant and Salisbury.

Quick answer: what is cholesteatoma?

A cholesteatoma is a pocket of skin that becomes trapped inside the ear. Over time it can collect keratin debris, become infected and erode bone. It can damage the hearing bones, affect balance structures and, rarely, lead to serious complications. It usually needs specialist ENT assessment and often requires surgery.

What symptoms can cholesteatoma cause?

The most typical symptom is a persistent or recurrent discharge from the ear. The discharge may be offensive-smelling and may not settle fully with repeated courses of ear drops or antibiotics.

Other symptoms include conductive hearing loss, a blocked or full sensation in the ear, tinnitus, ear discomfort, dizziness or imbalance. Some patients have a history of childhood ear disease, grommets, recurrent infections, eardrum retraction or a known perforation.

Severe pain, facial weakness, spinning vertigo, severe headache, swelling behind the ear or sudden worsening of hearing should be treated as urgent warning signs and should prompt same-day medical advice.

Why is cholesteatoma different from a simple ear infection?

A simple outer or middle ear infection may settle with appropriate treatment. Cholesteatoma is different because there is an underlying pocket of trapped skin that can repeatedly become infected and continue growing.

This means that repeated ear drops may temporarily reduce discharge, but they do not usually remove the underlying cholesteatoma. The aim of specialist treatment is to make the ear safe, dry and free from disease, while preserving or improving hearing where possible.

How is cholesteatoma diagnosed?

Diagnosis starts with a careful ENT examination of the ear canal and eardrum, ideally using a microscope or endoscope. The consultant looks for retraction pockets, keratin debris, perforation, granulation tissue, discharge and signs of chronic middle ear disease.

A hearing test is usually needed to understand the degree and type of hearing loss. CT imaging of the temporal bones may be requested to assess the middle ear and mastoid anatomy, particularly if surgery is being planned.

Can cholesteatoma be treated without surgery?

Ear drops, microsuction and cleaning can help control infection and discharge, especially while investigations are being arranged. In most fit patients, however, definitive treatment for cholesteatoma is surgical removal.

Observation may occasionally be considered in very selected cases, but this is not the usual approach for an active or growing cholesteatoma because of the risk of progressive damage.

What operation is used for cholesteatoma?

The operation is usually a tympanomastoid procedure, often referred to as mastoid surgery. The exact technique depends on the extent of disease, ear anatomy, hearing level, previous surgery and the surgeon’s assessment.

Some patients need reconstruction of the eardrum or hearing bones, known as tympanoplasty or ossiculoplasty. Others may need a staged approach, where a second planned procedure or MRI follow-up is used to check for recurrent or residual disease.

What are the goals of treatment?

The first priority is safety: removing disease and reducing the risk of complications. The next goals are to create a dry ear, reduce infections and preserve or improve hearing where possible.

Hearing outcomes vary because cholesteatoma can damage the tiny hearing bones. Your consultant will explain the likely hearing result, whether reconstruction is possible and whether hearing aids may still be useful after treatment.

Why choose specialist ENT assessment?

Chronic ear disease can be difficult to interpret without magnified examination, hearing tests and appropriate imaging. A specialist review helps distinguish wax, otitis externa, eardrum perforation, Eustachian tube dysfunction, chronic middle ear disease and cholesteatoma.

If you have persistent ear discharge, repeated infections or unexplained hearing loss, Hampshire ENT Clinics can provide prompt consultant-led assessment and a clear plan for investigation and treatment.

Frequently asked questions

Is cholesteatoma cancer?

No. Cholesteatoma is not cancer, but it can grow locally and damage important ear structures, so it needs proper assessment and treatment.

What does cholesteatoma discharge smell like?

It is often described as persistent, unpleasant or offensive-smelling. Not all ear discharge is cholesteatoma, but recurrent smelly discharge should be checked.

Can cholesteatoma cause hearing loss?

Yes. It can damage the eardrum, middle ear space and hearing bones, leading to conductive hearing loss. Some patients also have mixed hearing loss.

Can cholesteatoma cause dizziness?

Yes. Dizziness or imbalance can occur, particularly if the disease affects structures close to the balance system. Spinning vertigo should be assessed urgently.

Will ear drops cure cholesteatoma?

Ear drops may control infection or discharge temporarily, but they do not usually remove the underlying cholesteatoma.

Does cholesteatoma always need surgery?

Most active cholesteatomas need surgery if the patient is fit enough. The exact operation depends on the extent of disease and individual circumstances.

What is mastoid surgery?

Mastoid surgery is an operation to remove disease from the mastoid bone and middle ear. It is commonly used in cholesteatoma management.

Can cholesteatoma come back after surgery?

Yes, recurrence or residual disease can occur. Follow-up is important and may involve clinical review, hearing tests and MRI surveillance.

Is cholesteatoma urgent?

It is not usually a same-day emergency, but it should not be ignored. Facial weakness, severe dizziness, severe pain, swelling behind the ear or neurological symptoms require urgent care.

Can Hampshire ENT Clinics assess suspected cholesteatoma?

Yes. Hampshire ENT Clinics can assess chronic ear discharge, hearing loss, perforations and suspected cholesteatoma, with onward investigation and treatment planning where appropriate.