A cholesteatoma (kuh-less-tee-uh-TOE-muh) is a growth behind the eardrum, in the
middle part of the ear
where tiny bones relay sound waves from the eardrum to the inner ear.
As a cholesteatoma grows, it can damage the bones of the middle ear. This can lead
to hearing loss if it's not treated.
What Are the Signs & Symptoms of a Cholesteatoma?
A child with a cholesteatoma usually has fluid draining from the ear. Other signs
a feeling of pressure or pain in or behind the ear
ringing in the ear (tinnitus)
As a cholesteatoma grows, the child may also have:
problems moving the face muscles
An untreated cholesteatoma can continue to spread and damage surrounding bones.
Rarely, it can cause serious brain infections.
What Causes a Cholesteatoma?
Most cholesteatomas happen in kids who've had several ear
infections. Having a lot of ear infections can make the eardrum pull back into
the middle ear space and form a pouch. Skin cells can get trapped in the pouch. The
pouch can grow bigger and get infected.
Sometimes, a child is born with a cholesteatoma. A
(present at birth) cholesteatoma can grow for years without causing symptoms.
People with cleft
palates, craniofacial defects, and genetic problems (like Down
syndrome) are more likely to get a cholesteatoma.
How Is a Cholesteatoma Diagnosed?
Diagnosing cholesteatomas early can prevent many of the complications they can
Doctors suspect a cholesteatoma when they see:
a white mass behind the eardrum
other changes in the eardrum
ear drainage that continues for more than 2 weeks even with treatment
The doctor will refer a child with a cholesteatoma to an ear, nose, and throat
(ENT) surgeon, also known as an
. The ENT surgeon works with hearing specialists (audiologists) to see
how well the ear is working. They will do hearing
The ENT surgeon usually will order a CT
scan, which can show the small bony details of the ear clearly. The test results
help the surgeon:
confirm the diagnosis, if it's in doubt
How Is a Cholesteatoma Treated?
A cholesteatoma is removed with surgery while the child is under general
anesthesia. Removing it completely can be hard. The ENT surgeon may have to remove
the middle ear bones. Sometimes, more than one surgery is needed.
A child whose middle ear bones (called ossicles) are damaged might need more surgery
to improve hearing. The surgeon might replace missing or damaged ossicles with
or artificial parts.
Cholesteatoma can dissolve the bone over the facial nerve, which passes by the
middle ear bones. So, a special nerve monitor is used during surgery. Permanent damage
to the facial nerve from surgery is very rare.
What Else Should I Know?
Small congenital cholesteatomas can be completely removed and usually don't grow
back. Larger cholesteatomas and those that happen after ear infections are more likely
to grow back months or years after surgery.
Kids will need frequent ear exams and hearing tests for years after surgery to
make sure the cholesteatoma doesn't happen again.