Cholesteatoma Complications: Symptoms, Causes, Diagnosis and Treatment
Cholesteatoma can lead to serious complications including hearing loss, facial nerve damage, and life-threatening infections if left untreated.
Author: Dr. Sagar Rajkuwar (MS-ENT), ENT Specialist, Nashik, Maharashtra, India
Clinic: Prabha ENT Clinic, Ambad, Nashik
🌐 www.entspecialistinnashik.com
Table of Contents
- What Is Cholesteatoma?
- What Causes Cholesteatoma?
- What Are the Symptoms of Cholesteatoma?
- How Does Cholesteatoma Cause Complications?
- Cholesteatoma Complications
- How Is Cholesteatoma Diagnosed?
- When Is Cholesteatoma an Emergency?
- Treatment of Cholesteatoma
- Tympanomastoidectomy for Cholesteatoma
- Canal Wall-Up vs Canal Wall-Down Surgery
- Can Medicines Cure Cholesteatoma?
- Recovery and Follow-Up After Surgery
- Can Cholesteatoma Come Back?
- Frequently Asked Questions
- Summary
1. What is Cholesteatoma?
The middle ear and, potentially, the mastoid bone are often affected by a cholesteatoma, an uncommon buildup of keratinizing skin cells and debris.
A cholesteatoma is not a malignant tumor, despite its name. Nonetheless, it may behave destructively because it can expand and wear away the sensitive tissues and bone around the ear.
Cholesteatoma might be:
- Congenital, meaning it is there from birth.
- later in life.
Eustachian tube dysfunction, tympanic membrane retraction pockets, chronic ear infection, trauma, and prior ear surgery are all often linked to acquired cholesteatoma.
2. What is the cause of cholesteatoma?
Poor ventilation of the middle ear is a frequent method.
When the eustachian tube isn’t working as it should, there can be a buildup of negative pressure in the middle ear. Part of the eardrum can be pulled inward by this, forming a retraction pocket.
This cavity might collect dead skin cells. The collection may grow and become a cholesteatoma over time.
Other possible causes include:
- persistent otitis media
- Perforation of the eardrum
- Prior ear injury
- Prior Ear Operation
- Abnormalities present at birth
The precise process can differ from one patient to another.
3. What are the symptoms of cholesteatoma?
Symptoms of cholesteatoma are occasionally missed and it might develop gradually.
Typical symptoms include:
- Frequent or persistent ear discharge
- Foul-smelling discharge
- Slow hearing loss
- Fullness in the ear
- A sensation of discomfort or pain in the ear.
- Tinnitus
- Vertigo or dizziness
- Chronic ear infections
An ENT professional should evaluate a chronic, foul-smelling ear discharge that doesn’t significantly improve with standard care.
4. What are the mechanisms of cholesteatoma complications?
Bone erosion can occur as a result of the slow growth of a cholesteatoma.
The affected structures could be:
- Bones, little ones.
- Canal of the facial nerve
- Structures of the inner ear
- The mastoid bone
- Middle ear or mastoid tegment
- Sigmoid sinus-enveloping structures
In patients with advanced illness, the infection or erosion might spread to the interior of the skull.
Because of this, a cholesteatoma should not be seen as a basic ear infection.
5. Complications of Cholesteatoma
5.1 Hearing Loss
Among the most frequent consequences of cholesteatoma is hearing impairment.
The cholesteatoma might harm the ossicles, which are small bones that send sound through the middle ear.
This frequently results in conductive hearing loss.
Mixed hearing loss may result if the patient’s inner ear is also damaged, causing a sensorineural component.
The degree of hearing loss is determined by the area and scope of the illness.
5.2 Facial Palsy or Facial Nerve Weakness
Near the middle ear, the temporal bone is penetrated by the facial nerve.
Inflammation and compression can result from a cholesteatoma’s erosion of the facial nerve’s bony covering.
This can lead to:
- weakness in the face
- asymmetry in the face
- Trouble shutting one eye
- One side of the face sags.
Facial weakness is a serious warning indicator that necessitates quick ENT evaluation.
5.3 Inner ear damage and vertigo
A cholesteatoma can eat away at structures near the inner ear.
Erosion of the labyrinth, especially, can cause a labyrinthine fistula or other inner ear damage.
Symptoms might include:
- Dizziness
- Feeling lightheaded
- Problems with balance
- Vomiting
- Hearing loss of the sensorineural type
Therefore, vertigo in a patient with known or suspected cholesteatoma must be properly evaluated.
5.4 Chronic Foul-Smelling Discharge and Ear Infection
A persistent or recurring ear infection is commonly caused by cholesteatoma.
Keratin debris and dead skin might build up inside the lesion, promoting ongoing inflammation and infection.
Patients might observe:
- Ongoing ear discharge
- offensive odor
- Recurring infections
- Pain in the ears
- Diminishment of hearing
While antibiotic ear drops might help control any related infection, they won’t get rid of the cholesteatoma that’s causing it.
5.5 Tinnitus
In certain individuals with cholesteatoma, tinnitus can manifest as ringing, buzzing, humming, or other noises in the afflicted ear.
Tinnitus may be present with hearing loss or involvement of the middle or inner ear.
5.6. Erosion of the temporal bone and ossicles is
The tiny bones of hearing and other sections of the temporal bone might be corroded by the cholesteatoma.
Significant hearing loss can result from ossicular damage.
More widespread disease can include:
- Shield
- air cells of the mastoid bone
- Tegmen
- Canal of the facial nerve
- Maze
- Additional vital structures of the temporal bone
Cholesteatoma has been shown to erode the jugular bulb, intracranial structures, tegmen, and sigmoid sinus.
5.7 Meningitis:
Infection brought on by an advanced cholesteatoma can spread toward the meninges and result in meningitis, though it is unusual.
The symptoms may include:
- Intense headache
- Fever
- Stiffness in the neck
- Nausea and vomiting
- Sensitivity to light
- Alterations in consciousness or disorientation
A medical emergency is meningitis.
5.8 Brain Abscess,
Although uncommon, a brain abscess can be fatal.
It can happen when infection from severe ear disease goes beyond the temporal bone and affects intracranial structures.
Among the signs are:
- persistent or severe headache
- Fever
- Throwing up
- Perplexity
- Fragility
- Fainting Spells
- Changes in awareness
If a brain abscess is thought to exist, it needs to be examined right away in a hospital.
Epidural abscess and venous sinus thrombosis are additional uncommon intracranial side effects of cholesteatoma.
6. How Is Cholesteatoma Recognized?
A thorough ENT exam typically marks the beginning of the diagnosis.
The doctor might do the following:
Ear Check
You may use an otoscope or an operating microscope to discover:
- Retraction pockets
- Debris from keratin
- Eardrum perforation
- Tissue that granulates
- Unusual discharge
- Test of hearing
Determining the kind and severity of hearing loss is aided by pure-tone audiometry.
CT scan
A high-resolution CT may be used to assess the following:
- Erosion of bone
- Involvement of the mastoid bone
- Damage to the ossicular system
- Anatomy of the face channel
- Additional difficulties
- Diffusion-weighted imaging MRI
Cholesteatoma may be identified, and the residual or recurrent disease following surgery may be assessed using diffusion-weighted MRI, which may be extremely helpful.
7. When Is Cholesteatoma an Emergency?
Seek immediate medical help if cholesteatoma is accompanied by:
- Recent facial weakness
- Extreme giddiness
- Extreme headache
- Fever accompanied by worsening ear symptoms
- Perplexity
- Vomiting repeatedly
- loss of equilibrium
- Symptoms related to the nervous system
- A sharp and abrupt decrease in hearing capacity.
Intracranial structures, the inner ear, or the facial nerve may be affected by these symptoms.
8. Treatment of Cholesteatoma
The kind of therapy used is determined by the size, location, and condition of the patient’s ear, as well as the problems that may be present.
In most cases, surgical removal is the primary form of treatment for a cholesteatoma that has clinical importance.
Medications can be used to manage inflammation or infection, however they are not assured to completely cure the keratinizing disease.
The goals of therapy include:
- Cholesteatoma must be removed.
- Maintain a dry and safe ear.
- Manage infection.
- Protect key structures.
- When feasible, either maintain or enhance hearing.
- Lessen the likelihood of recurrence.
9. Tympanomastoidectomy for Cholesteatoma
When necessary, a tympanomastoidectomy combines mastoid surgery with surgery on the eardrum or middle ear.
Surgery may involve: depending on the illness.
- removal of cholesteatoma
- Mastoidotomy
- Tympanoplasty
- Reconstruction of ossicles
- Removing ailing tissue
- reconstruction of the tympanic membrane
The precise technique is customized based on the disease’s degree.
Consult our thorough manual on cholesteatoma surgery.
10. Canal wall-up vs canal wall-down surgery
There are two main surgical techniques to choose from.
Up the Canal Wall
The outside ear canal is still intact.
Although this method may result in a more natural anatomy of the ear canal, postoperative monitoring is essential since residual or recurrent illness is possible.
Canal Wall-Down
An open mastoid cavity is created by removing a portion of the posterior wall of the ear canal.
For specific patients with extensive disease or anatomy that necessitates this method for full disease clearance, this may be suitable.
The surgeon’s assessment, prior surgery, hearing condition, anatomy, and extent of the illness are some of the elements that influence the selection.
11. Can Medicines Cure Cholesteatoma?
A cholesteatoma can seldom be eradicated by medication alone.
Systemic antibiotics or antibiotic ear drops may be used if there is accompanying discharge and infection.
However, the underlying keratinizing lesion is not eliminated by medication.
As a result, patients who are thought to have cholesteatoma should be seen by an ENT/otologist rather than just receiving several rounds of antibiotics.
12. Recovery and Follow-Up After Surgery
The procedure performed and the degree of the condition determine how long it takes to recover.
Patients may briefly experience the following after surgery:
- fullness in the ear
- Lower hearing
- A little pain
- tinnitus
- Dizziness
- Taste alteration
Patients should adhere to their surgeon’s recommendations regarding:
- Care for your ears
- Maintaining dry ears
- Drops for ears
- Occupation
- To Fly
- Swimming
- follow-up appointments
Residual illness or the recurrence of cholesteatoma might occur; hence, long-term follow-up is crucial.
13. Can Cholesteatoma Come Back?
Yes.
It’s possible that cholesteatoma will persist or reappear after the procedure.
The risk varies according on a variety of criteria, such as:
- The scope of the initial sickness
- Operative strategy
- The patient’s age.
- Structure
- Whether the illness persisted in areas that were difficult to reach
Long-term clinical and, when necessary, imaging monitoring can aid in the detection of remaining or recurrent disease. Postoperative monitoring is greatly aided by non-echo-planar diffusion-weighted MRI.
14. Frequently asked questions
(1)Is cholesteatoma cancerous?
No. A cancerous tumor is not a cholesteatoma. However, it has the potential to slowly erode vital ear structures and nearby bone.
(2)Does cholesteatoma cause hearing loss?
It is. Hearing loss may result from harm to the ossicles and, in later stages, the inner ear.
(3)Can vertigo be caused by cholesteatoma?
Sure. Vertigo can result from the condition impacting balance-related structures, such as the labyrinth.
(4)Does facial paralysis result from cholesteatoma?
Yes, infrequently. Inflammation or erosion of the bones that surround the facial nerve can result in facial paralysis or weakness.
(5)Can meningitis be caused by cholesteatoma?
Intracranial issues like meningitis can occur in extreme circumstances when cholesteatoma is infected or advanced.
(6)Is it possible for cholesteatoma to lead to a brain abscess?
Extremely infrequently. One severe possible consequence of advanced cholesteatoma is an intracranial abscess.
(7)Are antibiotics effective in treating cholesteatoma?
No. While antibiotics can be used to treat secondary infection, they cannot consistently cure the cholesteatoma.
(8)Is surgery always necessary?
Most cholesteatomas of the middle ear that are medically significant need surgical treatment, however an ENT specialist must customize the treatment strategy.
15. Summary
Although not cancerous, cholesteatoma can be damaging to the ear. It may result in tinnitus, dizziness, hearing loss, and ongoing ear discharge.
It may damage the ossicles, facial nerve, inner ear, and temporal bone if it advances. It can infrequently lead to serious intracranial problems including meningitis, brain abscess, and venous sinus thrombosis.
Early diagnosis and suitable care are important.
Surgical removal of clinically significant cholesteatoma is usually the definitive treatment, with the surgical strategy chosen based on the degree of the illness and the patient’s specific characteristics. It’s also crucial to have long-term follow-up because there’s a chance of lingering or recurring illness.
Medical Disclaimer
Medical Disclaimer: This article is intended for general educational and informational purposes only. It does not replace an examination, diagnosis, or treatment plan from a qualified ENT specialist. Cholesteatoma can cause progressive damage and, rarely, serious complications. If you have persistent ear discharge, hearing loss, severe dizziness, facial weakness, severe headache, fever, or other concerning symptoms, seek prompt medical evaluation. Do not delay treatment or rely on online information for diagnosis.
Cholesteatoma – Organized Internal Link Categories
1. Cholesteatoma – General / Overview
- Cholesteatoma
- Ear Disease: Cholesteatoma
2. Cholesteatoma – Symptoms
- Cholesteatoma Symptoms
3. Cholesteatoma – Growth & Progression
- How Fast Does Cholesteatoma Grow?
4. Cholesteatoma – Treatment
- Cholesteatoma Treatment Without Surgery
- Cholesteatoma Pearl Treatment
5. Cholesteatoma – Surgery
- Cholesteatoma Surgery
6. Cholesteatoma – Recovery After Surgery
- What to Expect After Cholesteatoma Surgery
7. Cholesteatoma – Comparison / Differential Diagnosis
- Tympanosclerosis vs Cholesteatoma
Medical References
- NHS. Cholesteatoma. Updated February 20, 2025.
- StatPearls/NCBI Bookshelf. Middle Ear Cholesteatoma. Updated August 9, 2024.
- MSD Manual Professional Edition. Cholesteatoma.
- European Society of Head and Neck Radiology. ESR Essentials: Imaging of Middle Ear Cholesteatoma—Practice Recommendations.
- Prasad KC, et al. Extensive Cholesteatomas: Presentation, Complications and Management Strategy. Indian Journal of Otolaryngology and Head & Neck Surgery.
- Cholesteatoma—diagnosing the unsafe ear. PubMed.
