Cholesteatoma: symptoms, treatment, and when to worry
Last updated September 3, 2026.
A cholesteatoma is an abnormal collection of skin cells growing in the middle ear, usually behind a retracted eardrum. It is not a tumor and not cancer, but it does not go away on its own: it slowly expands, erodes the tiny hearing bones, and can reach the balance organ, the facial nerve, and, rarely, the brain lining. Treatment is surgery, and earlier is easier.
What causes it and what does it feel like?
Most cholesteatomas develop when poor Eustachian tube function pulls the eardrum inward into a pocket that traps skin, often after years of ear infections. Some are present from birth. The symptoms build slowly: persistent or recurrent smelly discharge from one ear, gradual hearing loss on that side, sometimes a feeling of fullness. Because it creeps rather than announces itself, a chronically discharging ear that keeps coming back despite drops is the presentation to take seriously.
What actually helps?
- ENT assessment for a chronically discharging ear: persistent one-sided discharge, especially foul-smelling, warrants a specialist look with an otoscope, not another course of drops.
- Imaging before surgery: a CT scan maps how far the growth has extended, and hearing tests document the baseline.
- Surgery is the treatment: an operation removes the cholesteatoma and repairs the eardrum and hearing bones where possible. It is usually a day-case or overnight procedure under general anaesthetic.
- Keep the ear dry meanwhile: water entering the ear feeds infection; plugs or a cotton ball with petroleum jelly for showers, and no swimming until cleared.
- Lifelong follow-up: cholesteatoma can recur, so post-surgical checks continue, sometimes with a planned second-look operation.
When is it an emergency?
Cholesteatoma grows slowly, but certain symptoms mean it has reached structures that cannot wait: facial weakness on that side, severe dizziness or vertigo, severe headache with fever and a stiff neck, confusion, or rapidly worsening pain and swelling behind the ear. Those are same-day emergency presentations. Pymander's escalation routing is built and tested specifically for this class of decision; see the safety architecture working paper.
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Common questions
Is a cholesteatoma a tumor or cancer?
No. Despite the name, it is not a tumor and not cancer: it is a sac of skin cells growing in the wrong place, the middle ear. The danger is mechanical, not malignant: it expands slowly, erodes the hearing bones, and can reach the balance organ, facial nerve, or brain lining. That is why it is removed surgically even though it is benign.
Can a cholesteatoma be treated with ear drops alone?
No. Drops and antibiotics control the discharge and infection episodes, but they cannot remove the skin sac, which keeps growing. Surgery is the only treatment that removes a cholesteatoma. Drops are the bridge, keeping the ear clean and quiet before the operation and during follow-up.
What does cholesteatoma surgery involve?
An operation, usually under general anaesthetic, to remove the growth from the middle ear and mastoid, repair the eardrum, and reconstruct the hearing bones where possible. Many are day cases. Depending on the technique, a planned second-look operation about a year later checks for residual disease and completes hearing reconstruction. Recovery involves keeping the ear dry and avoiding nose-blowing and heavy lifting initially.
Will my hearing come back after cholesteatoma surgery?
It depends on how much damage the growth did before removal. Surgery's first job is a safe, disease-free ear; hearing reconstruction is the second goal and is often done at a planned second stage. Hearing improves or stabilizes for many, but where the bones were badly eroded, some loss can persist, and a hearing aid is then a good option. Earlier surgery means more hearing to preserve.
Can cholesteatoma come back after surgery?
It can, which is why follow-up is part of the treatment rather than an optional extra: checks for years, and often a planned second-look procedure. Recurrence risk varies with the surgical technique and the original extent. Any return of discharge or worsening hearing after surgery should be reported promptly rather than waited out.
What happens if a cholesteatoma is left untreated?
It keeps expanding. In order of progression: hearing bones erode and hearing declines; the balance organ can be breached, causing vertigo; the facial nerve can be damaged, causing weakness on that side of the face; and rarely infection reaches the brain lining or forms an abscess, which is life-threatening. These complications are exactly what timely surgery prevents, and why a chronically discharging ear should never be managed with endless drops alone.