Cholesteatoma: Causes, Symptoms, Treatment and Pictures


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A Cholesteatoma is an abnormal, non-cancerous growth that develops in the middle ear behind the eardrum. It might be caused due to a congenital abnormality or the result of recurrent infection. These often develop as cysts, or sacs, that shed layers of old skin.

Pain in the ear, pus-like discharge and increased pressure in the ear can be some of the symptoms of cholesteatoma. Let’s read about Cholesteatoma, its representation by pictures, symptoms, causes, types, diagnosis, prevention, treatment, and more.

Disease Name Cholesteatoma

Chronic or recurring watery ear, Ear discharge, Hearing loss


Chronic ear infection, Sinus infection, Cold, Allergies

Diagnosis Physical examination, Hearing test, CT Scan, MRI
Treated by Otolaryngologists
Treatment Options Tympanomastoidectomy

What is Cholesteatoma?

Cholesteatoma is an abnormal non-cancerous cyst-like growth that grows behind the eardrum in the middle ear. It can be a birth defect or can be formed from repeated infection. The cyst can eventually become bigger which could damage the smaller bones in the ear.

Cholesteatoma Types

Cholesteatomas are benign collections of tissues in the middle ear. They are three major types of middle ear cholesteatomas:

  1. Primary acquired cholesteatoma: Primary cholesteatoma occurs when an unequal pressure and improper drainage in the eustachian tube. This results in a wax buildup due to the retraction of the eardrum into the middle ear.
  2. Secondary acquired cholesteatoma: Secondary acquired cholesteatoma is caused when the ruptured skin cells are collected behind the eardrum. 
  3. Congenital cholesteatoma: This defect is formed during fetal development. In this condition, the skin cells become trapped in the middle ear.

Cholesteatoma Symptoms

The symptoms associated with cholesteatoma generally start mild. The symptoms become severe when the cysts grow in size and affect the ear. Some of the signs and symptoms of cholesteatoma are:

  1. Dizziness
  2. Ear discharge. It can be:
    1. Dark
    2. Sticky 
    3. Foul-smelling
    4. Pus-like
    5. Similar to earwax
  3. Pain in ear
  4. Altered sense of smell
  5. Having a sensation of increased pressure in the ear 
  6. Numbness in ear
  7. Vertigo 
  8. Tinnitus( ringing in the ear)

Expert Doctors

Dr. Sharad Maheshwari

ENT, Ear Nose Throat

40+ Years




Dr. Meena Nihalani


25+ Years




NABH Accredited Hospitals

Apollo Cradle Maternity And Childrens Hospital

Apollo Cradle Maternity And Childrens Hospital

4.5/5( Ratings)
R-2 Near Nehru Place Flyover
BH Salvas Hospital

BH Salvas Hospital

4.8/5( Ratings)
Chandan Palace

Cholesteatoma Causes

Cholesteatoma can develop in any age group or gender. Cholesteatoma is caused due to many reasons. Some of the causes of cholesteatoma are:

  1. Chronic infections of the ear
  2. Sinus infection
  3. Cold
  4. Allergies

Cholesteatoma Risk Factors

Cholesteatoma develops due to the abnormal growth of the middle ear tissues. An individual is at a higher risk of developing cholesteatoma if he/she has:

  1. Down syndrome
  2. Turner syndrome
  3. Chronic ear infection
  4. Cleft palate
  5. Improper functioning of the Eustachian tube
  6. Having a family history of cholesteatoma
  7. Having multiple ear infections during childhood

Prevention of Cholesteatoma

Unfortunately, the congenital cholesteatoma cannot be prevented. However, an individual can take the following preventive measures for cholesteatoma to reduce the condition from worsening.

  1. In most cases, cholesteatoma is caused by ear infections. Therefore, diagnosing and treating ear infections at an early stage will help in preventing cholesteatoma
  2. Early treatment of cholesteatoma is necessary to prevent further complications.

How is Cholesteatoma diagnosed?

An ENT (ear, nose, and throat) specialist can diagnose a cholesteatoma using various methods such as:

  1. Physical examination: During a physical examination, the doctor will examine the ear using a device known as an otoscope. An otoscope is a device that delivers a beam of light for viewing the internal space of the ear.
  2. Hearing test: The doctor may also perform a hearing test known as an audiogram to access the eardrum, middle ear and hearing.
  3. CT scan (computerized tomography scan): This includes a series of X-rays showing a detailed picture of the internal structures like bones, blood vessels and tissues of the ear. This test helps in the examination of the damaged bones in the ear.
  4. MRI (Magnetic Resonance Imaging): This test may help the doctor detect the spread of the ear infection to the brain.

How to prepare for the doctor's consultation?

If an individual has signs or symptoms of a cholesteatoma, then consult the ear, nose and throat (ENT) specialist. Below mentioned are some of the information that a patient can prepare before the appointment with the specialist.

  1. List down symptoms including any that may seem unrelated to hearing loss, fluid discharge or other ear-related symptoms.
  2. List down the relevant events that may be related to the ear problems, such as a history of infections, recent ear injuries or head traumas, or recent air travel.
  3. The patient should also tell the specialist the list of medications and supplements he/she takes.
  4. Ask questions to the specialist. Some of the questions are as follows:
    1. What is the cause of my hearing loss?
    2. What is the best treatment for the condition?
    3. What type of follow-up appointments will I need?
    4. At what point do we need to consider other treatments?

Cholesteatoma Treatment

Once a cholesteatoma has been identified, an antibiotic treatment plan, ear drops, and meticulous ear cleaning will probably be advised to treat the infected cyst, lessen inflammation, and drain the ear. The cyst's growth characteristics can then be more thoroughly examined by the doctor, who can formulate a surgical removal strategy. Some of the treatment options for cholesteatoma are:

Cholesteatoma treatment without surgery

  1. Hearing aid: The doctor may also prescribe artificial hearing aid after completion of the surgery for better hearing.
  2. Medication: If there is an excessive fluid secretion in the ear due to an infection, it is necessary to dry the ear before surgery and prevent further infections after the surgery. The doctor may prescribe antibiotic ear drops to prevent further infection.

Cholesteatoma treatment with surgery

Almost all patients detected with cholesteatoma need one of the following surgery mentioned below.  In some cases, the combination of both surgeries may be necessary.

  1. Mastoidectomy: It involves the removal of the mastoid (bone behind the ear) in the ear. It is removed to stop the further spread of the infection. This surgery is of two types.
    1. Open cavity: In this approach, the whole mastoid bone is removed to form a cavity in the ear. This is why this surgery is called open surgery.
    2. Closed cavity: In this approach, the mastoid bone wall is preserved, leaving behind the canal-like cavity.
  2. Tympanoplasty: It involves the repair of the eardrum and hearing problems. The eardrum is repaired using a cartilage graft or the lining of the muscles behind the ear.
Surgery Name Surgery Cost
Mastoidectomy ₹55,000 to ₹75,000
Tympanoplasty ₹35,000 to ₹1,10,000

Risks and Complications of Cholesteatoma

Cholesteatoma can damage the bones in the middle ear or cause inner ear damage if not treated in time. Other risks and complications of cholesteatoma include:

  1. Brain abscess
  2. Meningitis
  3. Loss of hearing
  4. Spread of cyst into the brain
  5. Bone erosion may increase the chances of infection and other conditions like developing abscesses and causing facial paralysis

When to see a doctor?

The patient can consult the doctor if he/she experiences:

  1. Ear pain
  2. Hearing loss
  3. Ringing of ear
  4. Spinning sensation
  5. Nausea and vomiting

Diet for Cholesteatoma

Dietary habits cannot treat cholesteatoma. However, diet can help reduce the risk of developing the condition. Some minerals are also critical elements in improving hearing health. These include:

  1. Potassium: regulates the fluid in the inner ear. Foods rich in potassium include potatoes, spinach, lima beans, tomatoes, raisins, apricots, bananas, melons, oranges, yoghurt and low-fat milk
  2. Folic acid: helps the body to generate new cell growth and helps increase the circulation of blood in the body. Foods rich in folic acid include fortified breakfast cereal, liver, spinach, and broccoli.
  3. Magnesium: acts as a protective barrier to hair cells in the inner ear when loud noises are emitted. Foods rich in magnesium include bananas, potatoes, spinach and broccoli.
  4. Zinc: is known for increasing cell growth and healing wounds. Zinc-rich foods include cashews, almonds, peanuts, beans, and split peas.
  5. Omega 3 Fats and Vitamin D: have anti-inflammatory and anti-ageing properties. Foods rich in Omega 3s include flaxseed oil, krill oil, salmon, and soybean oil.

FAQs for Cholesteatoma

Cholesteatoma is an abnormal non-cancerous cyst-like growth that grows behind the eardrum in the middle ear. It can be a birth defect or can be formed from repeated infection.


The symptoms associated with cholesteatoma generally start mild. However, the cysts grow in size and affect the ear causing ear pain, dizziness, numbness in the ear, and vertigo.


Cholesteatoma can develop in any age group. Generally, it is caused due to chronic ear infections, sinus infections, colds or allergies.


Generally, cholesteatoma is rare, but if left untreated, it can damage the delicate structures inside the ear that are essential for hearing and balance.


The growth of the cholesteatoma cysts is really quick. If a single cell is left, then they can grow into pearls in 9 months which are easily visible and removable in a second look surgery.


Generally, cholesteatoma is not cancerous. However, they can lead to other complications such as hearing loss if they are left untreated.


If a cholesteatoma is diagnosed then surgical treatment is the only choice. The surgical methods to remove cholesteatoma include mastoidectomy and tympanoplasty.


The operation for cholesteatoma is performed under general anaesthesia and it usually takes about 2 to 3 hours to complete. 


The factors that increase the chances of developing cholesteatoma are chronic ear infections and poorly functioning eustachian tube.


Generally, when the cysts grow, it begins it creates a sense of pressure in the ear that may cause discomfort. This may further lead to aching pain in or behind the ear.


If a cholesteatoma is left untreated, it can continue to grow in size and in extreme cases can also start to affect the brain. This can cause pus or infection in the membrane in the brain.


Generally, patients feel dizziness and nausea after cholesteatoma surgery. 


The cost of cholesteatoma surgery is variable, considering the type of hospital chosen, the severity of the condition, the technique recommended, the patient's medical condition based on age and other health factors, etc. Contact HexaHealth for price transparency.


Yes, all health insurance plans cover the treatment for cholesteatoma. Paperwork is facilitated by our team on your behalf ensuring smooth approval and a cashless facility. Contact HexaHealth for a simple cashless and hassle-free experience.

Disclaimer: The information provided here is for educational and learning purposes only. It doesn't cover every medical condition and might not be relevant to your personal situation. This information isn't medical advice, isn't meant for diagnosing any condition, and shouldn't replace talking to a certified medical or healthcare professional.


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