Cholesteatoma: What This Ear Growth Is, How It's Found, and How It's Removed
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
A cholesteatoma is a growth behind the eardrum that forms when dead skin cells gather into a lump or cyst, usually because of a retracted or ruptured eardrum from chronic ear infections. [6] [7] Symptoms include smelly ear discharge, ear fullness, dizziness and recurrent infections. [7] It is treated only with surgery, and regular checkups are needed because it can come back. [7]
What the research says
According to PubMed:
Endoscopic ear surgery lowers the risk that a cholesteatoma comes back. In a meta-analysis of 13 studies, recurrence (RR 0.51; 95% CI 0.31–0.84) and residual disease (RR 0.68; 95% CI 0.47–0.99) were lower after endoscopic surgery than after microscopic surgery, while graft success, hearing results, and operation time did not differ significantly (Li et al., Am J Otolaryngol, 2021) [1].
A special MRI can find a returning cholesteatoma without a second operation. Across 32 studies, non-echo planar diffusion-weighted MRI detected recurrent or residual cholesteatoma with a pooled sensitivity of 92.2% (95% CI 87.3–95.3%) and specificity of 91.7% (95% CI 85.2–95.5%), mainly for moderate-to-large growths (Amoodi et al., Cureus, 2022) [2].
Congenital cholesteatoma is often found late. In one hospital's review of 1,646 patients with cholesteatoma, 18 had the congenital form (an intact eardrum with hearing loss), and 17 of them (94.4%) were already at stage III–IV when diagnosed (Wei et al., Int J Pediatr Otorhinolaryngol, 2023) [3].
What Is a Cholesteatoma?
A cholesteatoma is a growth behind your eardrum (tympanic membrane). [7] It develops when dead skin cells gather behind your eardrum to form a lump or cyst that may look like a pearl. [7]
Key terms at a glance: The tympanic membrane is your eardrum, the thin tissue that separates the outer ear from the middle ear. The middle ear is the air-filled space behind the eardrum where sound is carried deeper into the ear by tiny bones. An otolaryngologist is an ear, nose and throat (ENT) specialist.
Term | What it means |
Cholesteatoma | A growth behind the eardrum formed from dead skin cells, sometimes pearl-like |
Congenital cholesteatoma | Present from birth |
Acquired cholesteatoma | Develops over time, usually after ear problems |
Retracted eardrum | An eardrum pulled inward by an air-pressure imbalance |
You can be born with a cholesteatoma, but it usually happens because you have a retracted eardrum or a ruptured eardrum. [7]
Without treatment, cholesteatomas may become infected or grow large enough to damage your hearing and facial nerve. [6] [7] Surgery to remove the growth is the only way to treat a cholesteatoma. [5] [6] [7]
What Are Cholesteatoma Symptoms?
Symptoms vary depending on whether you are born with a cholesteatoma (congenital cholesteatoma) or develop one over time (acquired cholesteatoma). Congenital cholesteatomas may not cause symptoms until they get larger. Your child's pediatrician could find a congenital cholesteatoma in their ear while doing a physical examination. But both congenital and acquired forms of the condition may cause the following symptoms.
Symptom | What it is like |
Smelly discharge | A smelly discharge that may look like pus flowing from your ear or your child's ear — the most common symptom [7] |
Ear pressure | Pressure or a feeling of fullness in your ear [7] |
Dizziness | Feeling dizzy; the growth in your middle ear can affect your balance [7] |
Recurrent ear infections | Ear infections that keep coming back [7] |
Hearing loss | Sometimes the growth can cause hearing loss [7] |
Tinnitus | Sometimes a ringing in the ears [7] |
What Is the Main Cause of a Cholesteatoma?
One of the main causes is a retracted eardrum. [7] This is when there is an imbalance between the air inside and outside of your ear. This causes your middle ear to pull in your eardrum. When that happens, you may develop a cyst or pocket that fills up with skin cells and becomes a cholesteatoma.
Chronic ear infections (chronic otitis media) or ruptured eardrums can also lead to cholesteatomas. [6] [7] Rarely, children are born with the condition. [7]
Cause | How it leads to a cholesteatoma |
Retracted eardrum | Air imbalance pulls the eardrum inward, creating a pocket that fills with skin cells |
Ruptured eardrum | A tear in the eardrum lets skin cells gather behind it |
Chronic ear infections | Repeated infections set the stage for a retracted or ruptured eardrum |
Congenital (present at birth) | Rarely, children are born with the growth |
How Is a Cholesteatoma Diagnosed?
A healthcare provider will ask about your symptoms and medical history, including whether you have a history of ear infections. They will examine your ears with an otoscope, a device that lets them look at your eardrum. [7]
If they suspect you have a cholesteatoma, they will refer you to an ear, nose and throat specialist (otolaryngologist). [7] Your otolaryngologist may do the following tests.
What Are Treatments for a Cholesteatoma?
Treatments depend on the cause and symptoms, but surgeries like mastoidectomy and tympanoplasty are the only ways to remove a cholesteatoma. [7]
Key terms at a glance: A mastoidectomy removes infected bone in the mastoid (the bone behind the ear). A tympanoplasty repairs the eardrum. Ossicles are the tiny bones in your middle ear that carry sound.
Treatment | What it does |
Surgery (mastoidectomy) | Removes the growth and damaged bone; often needed to reach the full extent of the cholesteatoma |
Surgery (tympanoplasty) | Removes the growth and repairs the eardrum |
No non-surgical option |
What Can I Expect If I Have a Cholesteatoma?
If you are like most people, surgery to remove a cholesteatoma will take care of your symptoms. [7] But cholesteatomas can come back. [7] Your otolaryngologist may recommend that you have regular checkups. Checkups may include ear exams and hearing tests to check for signs of new cholesteatoma, and ear washing (debridement) to remove skin cells and other tissue build-up. [7]
When Should I See My Otolaryngologist?
Contact your otolaryngologist if you have symptoms after surgery like bleeding or discharge from your ear, ear pain, or a fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher. [7] You should also contact your otolaryngologist if you have symptoms like ear drainage that could mean you are developing a new cholesteatoma. [7]
Can Cholesteatomas Be Prevented?
You cannot prevent congenital cholesteatomas, but there are things you can do to reduce your risk that you will develop one. [7] Protect your ears from chronic infections or activities that could rupture your eardrum. Talk to a healthcare provider if you have recurring ear infections.
Prevention step | What it does |
Protect ears from chronic infections | Fewer infections lower the chance of a retracted or ruptured eardrum |
Avoid activities that could rupture the eardrum | Keeps the eardrum intact so skin cells cannot gather behind it |
See a provider for recurring ear infections | Early treatment stops the cycle that leads to the growth |
What is the bottom line on cholesteatoma?
A cholesteatoma is a growth that forms behind your eardrum when dead skin cells collect into a lump or cyst that may look like a pearl. It is usually linked to a retracted or ruptured eardrum — most often the result of chronic ear infections — and rarely, people are born with it. The telltale sign is a smelly, pus-like discharge from the ear, often with pressure, dizziness, recurrent infections, and sometimes hearing loss or tinnitus. Left untreated, the growth can become infected and damage your hearing and facial nerve, which is why surgery — like a mastoidectomy or tympanoplasty — is the only treatment. For most people, surgery takes care of symptoms, but because cholesteatomas can return, regular ENT checkups, hearing tests, and ear cleaning are part of long-term care. If you notice smelly ear drainage or any ear changes, talk to a healthcare provider early — treatment works best before the growth gets large.
Frequently Asked Questions
What is a cholesteatoma?
A growth behind your eardrum that develops when dead skin cells gather into a lump or cyst that may look like a pearl.
What does cholesteatoma mean?
The word describes the growth itself — a pearl-like cyst of dead skin cells behind the eardrum.
Can you be born with a cholesteatoma?
Yes. Some people are born with one (congenital cholesteatoma), though this is rare. These may not cause symptoms until they get larger and are sometimes found by a pediatrician during a physical exam.
What causes a cholesteatoma?
Usually a retracted eardrum (pulled inward by an air-pressure imbalance), a ruptured eardrum, or chronic ear infections. Rarely, children are born with the condition.
What is a retracted eardrum?
When there is an imbalance between the air inside and outside of your ear, your middle ear pulls in your eardrum — which can create a pocket that fills with skin cells and becomes a cholesteatoma.
What are the symptoms?
The most common is a smelly discharge that may look like pus flowing from your ear. Others include ear pressure or fullness, dizziness, recurrent ear infections, and sometimes hearing loss or tinnitus.
Is a smelly ear discharge always a cholesteatoma?
Not necessarily — but a smelly, pus-like discharge from the ear is the most common cholesteatoma symptom, so it should always be checked by a healthcare provider.
How is a cholesteatoma diagnosed?
A provider asks about your symptoms and history of ear infections and examines your ear with an otoscope. If suspected, you are referred to an ENT specialist (otolaryngologist), who may order a CT scan to check the ear bones and hearing tests including tympanometry.
What is an otolaryngologist?
An ear, nose and throat specialist.
Why do I need a CT scan?
To see whether the cholesteatoma is damaging your ossicles — the tiny ear bones that carry sound.
Can a cholesteatoma be treated without surgery?
No. Surgery is the only way to remove a cholesteatoma.
What surgeries treat a cholesteatoma?
Surgeries like mastoidectomy (removing the growth and affected bone) and tympanoplasty (removing the growth and repairing the eardrum).
Will surgery fix my symptoms?
If you are like most people, yes — surgery to remove the cholesteatoma takes care of your symptoms.
Can a cholesteatoma come back?
Yes. Cholesteatomas can return, which is why regular checkups are recommended.
What happens at follow-up checkups?
Ear exams and hearing tests to check for signs of a new cholesteatoma, plus ear washing (debridement) to remove skin cells and other tissue build-up.
When should I call my doctor after surgery?
If you have bleeding or discharge from your ear, ear pain, or a fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher.
What if I get ear drainage again later?
Contact your otolaryngologist — ear drainage could mean you are developing a new cholesteatoma.
Can a cholesteatoma damage my hearing?
Yes. Without treatment, cholesteatomas can become infected or grow large enough to damage your hearing and your facial nerve.
Can cholesteatomas be prevented?
Congenital ones cannot be prevented, but you can lower your risk of developing one by protecting your ears from chronic infections and activities that could rupture your eardrum, and by seeing a provider for recurring ear infections.
Is a cholesteatoma dangerous?
A cholesteatoma can be — left untreated, it may become infected and damage your hearing and facial nerve. But with timely surgery and follow-up care, most people do well.
Related Reading
This article is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the guidance of a physician or other qualified health provider with any questions you have about a medical condition. Never disregard professional medical advice or delay seeking it because of something you read here. A cholesteatoma can damage your hearing and facial nerve if left untreated — if you have smelly ear discharge, hearing loss, dizziness, or ear pain, especially with a fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, seek medical care promptly.
References
Li B, Zhou L, Wang M, et al. Endoscopic versus microscopic surgery for treatment of middle ear cholesteatoma: a systematic review and meta-analysis. Am J Otolaryngol. 2021;42(2):102451. PMID 33360773. https://doi.org/10.1016/j.amjoto.2020.102451
Amoodi H, Mofti A, Fatani NH, et al. Non-echo planar diffusion-weighted imaging in the detection of recurrent or residual cholesteatoma: a systematic review and meta-analysis of diagnostic studies. Cureus. 2022;14(12):e32127. PMID 36601207. https://doi.org/10.7759/cureus.32127
Wei B, Zhou P, Zheng Y, et al. Congenital cholesteatoma clinical and surgical management. Int J Pediatr Otorhinolaryngol. 2023;164:111401 (published online December 8, 2022). PMID 36512880. https://doi.org/10.1016/j.ijporl.2022.111401
Castle JT. Cholesteatoma pearls: practical points and update. Head Neck Pathol. 2018;12(3):419-429. PMID 30069838. https://doi.org/10.1007/s12105-018-0915-5
Kuo CL, Shiao AS, Yung M, et al. Updates and knowledge gaps in cholesteatoma research. Biomed Res Int. 2015;2015:854024. PMID 25866816. https://doi.org/10.1155/2015/854024
Pachpande TG, Singh CV. Diagnosis and treatment modalities of cholesteatomas: a review. Cureus. 2022;14(11):e31153. PMID 36505121. https://doi.org/10.7759/cureus.31153
Cleveland Clinic. Cholesteatoma. Cleveland Clinic. Last updated February 13, 2024. https://my.clevelandclinic.org/health/diseases/21535-cholesteatoma
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