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.
A child with a cholesteatoma usually has fluid draining from the ear. Other signs include:
As a cholesteatoma grows, the child may also have:
An untreated cholesteatoma can continue to spread and damage surrounding bones. Rarely, it can cause serious brain infections.
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 congenital (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.
Diagnosing cholesteatomas early can prevent many of the complications they can cause.
Doctors suspect a cholesteatoma when they see:
The doctor will refer a child with a cholesteatoma to an ear, nose, and throat (ENT) surgeon, also known as an otolaryngologist . The ENT surgeon works with hearing specialists (audiologists) to see how well the ear is working. They will do hearing tests (audiometry).
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:
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 cartilage 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.
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.
Reviewed by: William J. Parkes, IV, MD
Date Reviewed: Jul 1, 2019
