What is a cholesteatoma?
MedlinePlus describes a cholesteatoma as a type of skin cyst located in the middle ear and the mastoid bone in the skull. The NHS calls it a build-up of dead cells inside the ear that can cause hearing loss, tinnitus and dizziness. It is rare and usually affects only one ear.
It is not a tumor and has nothing to do with cholesterol, despite the name. The problem is that, as MedlinePlus explains, cholesteatomas very often continue to grow if they are not removed. The cyst may become infected or get bigger and break down some of the middle ear bones or other structures, which can affect hearing, balance and possibly the facial muscles.
How a cholesteatoma forms
MedlinePlus explains that it more commonly occurs as a result of chronic ear infection. The eustachian tube helps equalize pressure in the middle ear. When it does not work well, negative pressure can build up and pull part of the eardrum inward, creating a pocket that fills with old skin cells and other waste material. Our guide on eustachian tube dysfunction explains that problem in more detail.
The NHS adds that a cholesteatoma can develop when the eardrum is damaged by injury, infection or any kind of ear surgery. Some people are born with one (congenital cholesteatoma), but this is rare. MedlinePlus notes that prompt and thorough treatment of chronic ear infection may help prevent it.
Ear discharge and hearing loss
The most common symptoms listed by the NHS are:
- a watery, smelly discharge that comes out of the ear, which MedlinePlus notes can be chronic
- a gradual loss of hearing in the affected ear
- pain in the affected ear
MedlinePlus also mentions a feeling of fullness or pressure in the ear. Because the discharge can look like an ordinary ear infection, a key clue is that it keeps coming back or does not clear with treatment. Our guide on ear drainage covers other causes of fluid coming from the ear.
Dizziness, tinnitus and other signs
A cholesteatoma can also cause:
- ear infections that keep coming back
- vertigo or dizziness
- tinnitus (ringing or other noises in the ear)
- damage to the facial nerve, which can cause weakness or paralysis of the face
Rarely, an infected cholesteatoma can lead to a brain abscess or meningitis, or spread into the brain, according to MedlinePlus. These complications are the reason the condition should not be left untreated.
When to see a doctor and when it is urgent
The NHS advises seeing a GP if:
- you are having problems with your hearing
- discharge from your ear does not go away after taking prescribed antibiotics
- you have ear pain for more than 3 days that does not go away
MedlinePlus advises contacting your provider if ear pain, ear discharge or other symptoms occur or worsen, or if hearing loss occurs. Sudden facial drooping, arm weakness or speech problems are not typical of a cholesteatoma and need an emergency call, because they can be signs of a stroke.
How cholesteatoma is diagnosed
A doctor first examines the inside of your ear. MedlinePlus explains that the exam may show a pocket or a hole (perforation) in the eardrum, often with drainage, and a deposit of old skin cells may be seen with a microscope or an otoscope. If an infection caused by a cholesteatoma is suspected, the GP may prescribe ear drops and refer you to an ear, nose and throat (ENT) specialist for more tests, including a CT scan.
If you have dizziness, MedlinePlus lists other tests that may be used to look for other causes: a head CT scan, a head MRI scan and electronystagmography, a test of eye movements related to balance.
Treatment: why surgery is usually needed
Ear drops or antibiotics can treat an infection, but they do not remove the cholesteatoma. The NHS explains that you will usually have surgery in hospital to remove the build-up of dead skin cells under general anesthesia. You may go home the same day or stay overnight, longer if there are problems. Stitches and packing may be placed in the ear and removed after a few weeks.
MedlinePlus says surgery is most often successful, although you may need the ear cleaned by a health care provider from time to time. If a cholesteatoma affects your hearing, surgery may help to improve it, but the NHS is clear that it does not always help: hearing may stay the same or possibly get worse. Before surgery it is worth asking your surgeon what the operation aims to achieve for your hearing, how often you will be checked afterwards, and which new symptoms should make you call.
In our ENT practice in Bilbao we assess adults with long-lasting ear discharge or hearing loss in one ear (consultations are in Spanish).
Recovery after surgery and long-term follow-up
Recovery can take time and can be painful. The NHS says most people take 6 to 8 weeks to fully recover and may be advised not to work for 1 to 2 weeks or longer. Its practical advice includes:
- keep the ear dry when showering, and plug it with a small piece of cotton wool coated in petroleum jelly when washing your hair
- avoid swimming for at least 6 weeks if you can
- do not blow your nose until the surgeon says so (sniffing is fine), and try to keep your mouth open if you sneeze
- check with the surgeon before traveling by plane
Even after a good recovery, you will need long-term follow-up to check there are no problems. If surgery did not completely remove the cholesteatoma, or if it comes back, another procedure may be needed.
Where the sources differ
Main cause. MedlinePlus presents chronic ear infection and a poorly working eustachian tube as the most common cause. The NHS describes damage to the eardrum from injury, infection or ear surgery, without singling out one mechanism.
Pain. The NHS lists ear pain among the common symptoms; MedlinePlus does not include pain in its symptom list, but mentions it among the reasons to contact a provider.
Recovery time. The NHS gives 6 to 8 weeks for most people; MedlinePlus gives no time frame. This is a general figure, not a fixed timetable: your surgeon decides when you can return to work, swim or fly.
In summary
A cholesteatoma is a build-up of dead skin cells in the middle ear, usually on one side. Smelly, watery discharge that keeps coming back, gradual hearing loss and ear pain are the typical signs; dizziness, tinnitus and facial weakness can also appear.
Antibiotics treat infection but do not remove the cyst, which usually needs surgery. Recovery takes several weeks, hearing does not always improve, and long-term follow-up is needed because the cholesteatoma can come back.
Frequently asked questions about cholesteatoma
These answers are general information and do not replace an examination or individual medical advice.
How serious is cholesteatoma?
It is not cancer, but it usually keeps growing if it is not removed and can damage the ear bones, hearing, balance and the facial nerve. Rarely, infection can cause meningitis or a brain abscess, so it needs treatment.
What is the most common cause of cholesteatoma?
MedlinePlus says it most often results from chronic ear infection, when a poorly working eustachian tube pulls part of the eardrum inward. Eardrum damage from injury or surgery can also cause it, and a few people are born with it.
What are the symptoms of a cholesteatoma?
A watery, smelly discharge from one ear, gradual hearing loss on that side and ear pain are the most common. Repeated ear infections, dizziness, tinnitus and facial weakness can also occur.
Can cholesteatoma be cured?
Surgery is most often successful at removing it. Long-term follow-up is still needed, because it can come back or may not have been completely removed, and another operation may then be necessary.
Can antibiotics remove a cholesteatoma?
No. Ear drops or antibiotics can treat an infection linked to it, but the build-up of skin cells itself usually has to be removed with surgery.
Why is long-term follow-up needed?
Because a cholesteatoma can come back after surgery, or small parts may remain. Regular check-ups allow problems to be found early, and the ear may need cleaning from time to time.
Sources
- NHS · Cholesteatoma (page last reviewed 20 February 2025)
- MedlinePlus Medical Encyclopedia · Cholesteatoma (review date 4/29/2026)
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.