A cholesteatoma is not actually a tumor, even though the name sounds like one—it’s an abnormal growth of skin cells inside the middle ear (behind the eardrum).

Here’s the key breakdown:

What it is

• A collection of skin cells and keratin that can grow and damage delicate structures of the ear.

• Can be congenital (present at birth) or acquired (develops later, often after repeated ear infections or eardrum perforation).

Why it’s a problem

• It can erode the tiny hearing bones (ossicles), leading to hearing loss.

• If untreated, it can spread to nearby areas and cause:

  • Persistent ear drainage (foul-smelling)

  • Balance problems

  • Facial muscle weakness (if it affects the facial nerve)

  • Rarely, serious complications like meningitis or brain abscess.

Symptoms

• Recurrent ear discharge (often smelly)

• Hearing loss (gradual, in one ear)

• Sometimes ear fullness, pain, or dizziness

• In advanced cases: facial droop or severe headache

Causes

• Poor eustachian tube function → negative pressure in the middle ear → retraction pocket in eardrum → skin cells collect and form cholesteatoma.

• Chronic ear infections.

• Sometimes after surgery or trauma.

Diagnosis

• Ear examination with an otoscope or microscope

• Hearing tests (audiometry)

• CT scan of the temporal bone if needed

Treatment

• Surgery is the main treatment (called mastoidectomy or tympanomastoidectomy), because the growth won’t go away on its own.

• Goal: Remove the cholesteatoma, prevent recurrence, and restore hearing if possible.

• Lifelong follow-up may be needed since it can come back.