Department of Otolaryngology / Head and Neck Surgery

Cholesteatoma

Cholesteatoma is the presence of skin behind the tympanic membrane. It is thought to be the consequence of long-term problems with the eustachian tube. When the Eustachian tube is obstructed, a negative pressure develops behind the eardrum. If not relieved, the eardrum may partially collapse and form a pocket or cyst. As the eardrum skin grows it collects within the cyst, causing it to expand. As it expands it may damage the other structures in the ear, leading to hearing loss. The other problem is infection. The old skin cells decay and may become a focus of bacterial or fungal infection. This leads to chronic drainage, which may smell very bad.

The treatment is surgical removal, often done in two stages. The first stage is to remove the cyst and any infection. The second stage occurs in about 6 months. At that time the hearing mechanism may be reconstructed. Recurrence rates are about 15%, but are easily treatable.

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