Cholesteatoma: why is treatment necessary?

Written by: Mr Abhijeet Parikh
Published: | Updated: 06/07/2023
Edited by: Laura Burgess

Accumulation of skin cells in the middle ear is called cholesteatoma. The cells form a cyst that grows toward the middle and inner ear. Although cholesteatomas are not cancerous (benign), if left untreated they can lead to problems such as hearing loss.

Close up of ear of a woman who could have cholesteatoma.

Leading London otolaryngologist Mr Abhijeet Parikh explains why it’s important for cholesteatoma to be treated and what possible complications could arise in the ear if it isn’t.


Why does a cholesteatoma need treatment?

Cholesteatoma needs treatment:

a) To stop ear infection(s)

  • Skin cells are a rich source of nutrients for bacteria that cause an infection. This leads to a characteristic foul-smelling discharge from the ear.

b) To stop hearing loss

  • As it grows within the small middle ear space, the cholesteatoma erodes the small bones that transmit sound (ossicles). This causes a progressive hearing loss.

c) To prevent other complications (uncommon)

  • Important structures around the middle ear such as the balance system and facial nerve can be involved in the erosive process leading to imbalance, vertigo and facial palsy.
  • Rare complications include meningitis or a brain abscess if the cholesteatoma breaks through the confines of the small middle ear space and abuts the brain and its lining.

Is cholesteatoma dangerous?

What are the symptoms of cholesteatoma?

If you have cholesteatoma its main symptoms are:

  • Foul-smelling discharge from the ear, sometimes bloodstained
  • Progressive hearing loss

How is cholesteatoma diagnosed?

  • Diagnosis is made on ear examination
  • Examination with a microscope and suction cleaning of any discharge is very useful to gauge the extent of the cholesteatoma
  • A CT scan is done to further evaluate its extent and closeness to vital structures mentioned above.


How is cholesteatoma treated?

Infection and foul-smelling discharge can be treated by cleaning the ear (micro-suction) and a short course of topical antibiotic drops.

However, the definitive treatment of cholesteatoma is surgical. The procedure is called a mastoid exploration. The aim of surgery is to remove the cholesteatoma, preventing its progression and complications as mentioned in 2c above.


The disease can recur, and thus more than one operation may be needed for complete removal. Repair of the ossicles and improvement of hearing can be addressed during surgery but is not its primary aim.




If you are concerned you have a cholesteatoma, do not hesitate to book an appointment with Mr Abhijeet Parikh via his Top Doctors profile

By Mr Abhijeet Parikh
Otolaryngology / ENT

Mr Abhijeet Parikh is an eminent consultant ear, nose and throat surgeon practising in his private clinics in London. With particular specialisation in hearing loss, ear infections, and other problems related with the ear, he is also expert in a wide range of ENT procedures, including nose and voice problems.

Mr Parikh completed studies in Mumbai before moving to the UK to continue his studies and experience. He achieved his PhD after undertaking a research position studying aspirin-sensitive patients being treated for nasal polyps with Dr Glenis Scadding.

Alongside his clinical practice, Mr Parikh devotes time to teaching the next generation of ENT surgeons and doctors. He has published over 40 peer-reviewed articles and contributed to a number of chapters in books in his field of expertise.

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