Cholesteatoma
Cholesteatoma is a rare but serious condition in children where a skin growth develops in the middle ear behind the eardrum. Cholesteatoma can be destructive over time, as the growth can expand and damage the bones of the middle ear, the eardrum, and nearby structures. It often starts with repeated ear infections from poorly functioning Eustachian tube. Cholesteatoma can be present at birth (congenital cholesteatoma), or more commonly develop over time (acquired cholesteatoma). Early diagnosis and treatment are important to prevent long-term complications.
Common symptoms of cholesteatoma in children include persistent or smelly ear drainage (otorrhea), hearing loss in the affected ear, a feeling of fullness or pressure, and sometimes ear pain. In more advanced cases, children may experience dizziness, balance problems, or facial muscle weakness if nearby nerves are affected. These symptoms can be mistaken for a regular ear infection, which is why persistent symptoms should be evaluated by an otolaryngologist (ear, nose and throat doctor).
The workup for cholesteatoma begins with an ear examination using an otoscope or a microscope. Hearing tests (audiograms) are typically done to assess the degree of hearing loss. If cholesteatoma is suspected, a CT scan of the temporal bone is recommended to determine the extent of the growth and see if it has damaged nearby structures. Early imaging helps guide treatment and surgical planning.
Medical management alone cannot cure cholesteatoma, but it may help control symptoms temporarily. Doctors may prescribe antibiotic ear drops or oral antibiotics to treat any active infection and reduce inflammation. However, these measures are only supportive. Since cholesteatomas continue to grow and can cause increasing damage, surgical removal is recommended once the diagnosis is confirmed.
Surgery is the main treatment for cholesteatoma. The goal is to completely remove the growth and prevent it from coming back while preserving or restoring hearing. This surgery is called a tympanomastoidectomy, and it is typically done under general anesthesia. Sometimes more than one surgery is needed — a second-look operation may be scheduled to ensure all the cholesteatoma tissue was removed. After surgery, children will need regular follow-up appointments and hearing tests. With early diagnosis and proper treatment, most children recover well and can return to normal hearing and activities. Please contact us to arrange a visit if you are concerned your child may have a cholesteatoma.