Understanding cholesteatoma: causes, symptoms & treatment

A cholesteatoma is a rare but serious ear condition that occurs when skin cells grow abnormally in the middle ear, behind the eardrum. While it isn’t cancerous, it can lead to hearing loss and other complications if left untreated.

At Leightons, we know ear health issues can feel worrying. The good news? Cholesteatoma can be managed effectively with the right care - starting with an accurate diagnosis. Regular hearing checks are essential for spotting early signs, and our expert audiologists are here to guide you every step of the way.

What is a cholesteatoma?

A cholesteatoma is an abnormal, non-cancerous, abnormal growth of skin cells and debris that forms a cyst-like pocket, usually behind the eardrum. Over time, this growth can put pressure on the delicate bones of the ear, causing damage if untreated.

There are two main types:

· Congenital cholesteatoma: present from birth and often detected during childhood.

· Acquired cholesteatoma: develops later, usually due to chronic ear infections or eardrum issues.

If untreated, cholesteatoma can erode bone, cause persistent infections, and affect balance and hearing. Early detection is key.

What causes cholesteatoma?

Occasionally, no clear cause is identified, but any condition that interferes with ear ventilation or healing after infection can increase risk. The middle ear is designed to stay clean and dry, but certain factors can interfere with this balance:

· Chronic ear infections: Repeated infections can cause the eardrum to retract, creating a pocket where skin cells can collect and grow.

· Eustachian tube dysfunction: The tube helps equalise air pressure between the middle ear and the outside environment. When it doesn’t work properly, pressure changes can pull the eardrum inward, encouraging a cholesteatoma to form.

· Perforated eardrum: A hole or tear in the eardrum can allow skin cells from the outer ear to move into the middle ear space.

Occasionally, no clear cause is identified, but any condition that interferes with ear ventilation or healing after infection can increase risk.

Recognise the symptoms of cholesteatoma

Cholesteatomas grow slowly, so symptoms may be subtle at first. Recognising the warning signs can help you seek treatment sooner and protect your hearing.

Typical symptoms include:

· Persistent or foul-smelling ear discharge that doesn’t clear up with standard treatments

· Hearing loss in one ear, often gradual

· A feeling of fullness or pressure in the affected ear

· Intermittent ear pain or discomfort

· Occasional dizziness or balance issues

· In some cases, a buzzing or ringing sound (tinnitus)

If left untreated, a cholesteatoma may lead to repeated infections, worsening hearing loss, or, in rare cases, facial muscle weakness. If you notice these symptoms, it’s important to have your ears checked by a professional.


How is cholesteatoma diagnosed?

An accurate diagnosis is the first step toward effective management. Because cholesteatomas can look similar to other ear conditions, professional examination is essential.

During your hearing appointment, your audiologist will:

· Use an otoscope to look inside the ear and check for signs of fluid, inflammation, or a growth behind the eardrum.

· Test your hearing to measure any hearing loss or changes.

If they detect potential warning signs through a professional ear health check and, if a cholesteatoma is suspected, we’ll explain your results clearly and refer you to an ENT specialist for medical care.

Treatment and management

Cholesteatoma does not resolve on its own - medical or surgical treatment might be required. The goal of treatment is to remove the cholesteatoma, stop infection, and protect your hearing. As the condition does not go away on its own, medical or surgical intervention is often required.

Treatment may include:

· Medication: Antibiotic ear drops or oral medication may help control infection or reduce inflammation before surgery.

· Surgery: The most common treatment, performed by an ENT specialist under general anaesthetic, involves removing the cholesteatoma and repairing damage to the eardrum or middle ear bones.

· Reconstruction: In some cases, reconstructive surgery (tympanoplasty) may be needed to restore hearing.

· Ongoing care: Regular check-ups are vital, as cholesteatomas can recur. Your hearing should be monitored to ensure it remains stable after surgery.

When to see a professional

You should seek advice if you experience:

· Persistent ear discharge that lasts longer than a week

· Gradual or unexplained hearing loss in one ear

· A sense of fullness, pressure, or popping in the ear

· Recurring ear infections or discomfort

If you’re unsure about your symptoms, booking an ear health check is a simple first step. Our audiologists can identify any signs of concern and guide you to the right care.

Book a free hearing test with Leightons

Our experienced audiologists can safely examine your ears, check for infection, wax build-up, or inflammation, and refer you for medical attention if needed.

We’re here to help you understand your symptoms, protect your hearing, and live life to the full.

Book your ear health check today.

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Understanding mastoiditis: causes, symptoms & treatment
Understanding mastoiditis: causes, symptoms & treatment
Mastoiditis is a rare but serious ear infection that affects the mastoid bone, which sits just behind the ear. It usually develops when a middle ear infection (otitis media) spreads to the mastoid bone, causing inflammation and fluid build-up. Although it sounds alarming, mastoiditis can be successfully treated with prompt medical care. At Leightons, we understand that ear pain and swelling can be worrying. Our audiologists are here to check your ear health, explain what’s happening, and help guide you to the right care if an infection is suspected. What is mastoiditis? The mastoid bone is part of your skull and contains small air-filled spaces that help drain the middle ear. When bacteria from an untreated or severe ear infection spread to this bone, it can become inflamed and filled with infected fluid. This condition is known as mastoiditis. If not treated quickly, the infection can cause pain, swelling, and in some cases, damage to nearby structures - which is why early diagnosis and medical treatment are essential. What causes mastoiditis? Mastoiditis most often develops as a complication of a middle ear infection that hasn’t fully cleared. When bacteria remain trapped in the middle ear, they can spread into the mastoid bone, causing inflammation and infection. Common causes and contributing factors include: Untreated or chronic ear infections Bacterial infection spreading from the middle ear Recurrent infections weakening ear tissues Poor ear drainage due to Eustachian Tube Dysfunction Mastoiditis can occur at any age but is more common in children, as their ear structures are still developing. Common symptoms of mastoiditis Mastoiditis symptoms can appear suddenly and may follow an ear infection that hasn’t fully resolved. Common signs include: Severe, persistent ear pain Swelling or redness behind the ear Ear discharge (sometimes thick or pus-like) Fever and feeling unwell Hearing loss in the affected ear Headache or dizziness In some cases, the ear may appear pushed forward due to swelling behind it. Because mastoiditis can worsen quickly, it’s important to seek medical attention if you notice these symptoms. How is mastoiditis diagnosed? A GP or ENT specialist can diagnose mastoiditis by examining the ear and checking for inflammation, swelling, or discharge. Tests may include: Otoscopy: Looking inside the ear to assess infection Hearing test (audiogram): Checking if hearing has been affected CT scan: To confirm if the infection has spread to the mastoid bone Blood tests: To detect signs of infection Early diagnosis allows for quicker treatment and prevents complications. Treatment for mastoiditis Treatment aims to remove the infection, relieve symptoms, and prevent further spread. Depending on the severity, this may involve: Antibiotics: Usually given intravenously (via a drip) to control the infection Ear drainage: A small procedure to remove infected fluid or pus Surgery (mastoidectomy): In more serious cases, part of the infected bone may be removed to stop the infection from spreading With prompt treatment, most people recover fully and experience no long-term hearing damage. Preventing mastoiditis The best way to prevent mastoiditis is by treating ear infections early and avoiding irritation to the ear canal. Simple steps include: Seek medical advice for any ear infection that lasts more than a few days Avoid inserting objects like cotton buds into your ears Keep ears dry and clean, especially after swimming Attend regular ear health checks to monitor your ear condition if you’re prone to infections By managing ear health proactively, you can reduce the risk of complications like mastoiditis. How Leightons can help At Leightons, we provide ear health checks and free hearing assessments to help identify infections early and support your recovery after treatment. Our audiologists can: Examine your ears safely for signs of infection or inflammation Carry out hearing tests to check for any hearing changes Refer you to an ENT specialist for medical treatment if necessary Offer aftercare and follow-up checks to monitor your ear health after recovery We’re here to help you understand your symptoms, protect your hearing, and feel confident in your ear health. Book your free hearing assessment today and take the first step toward clearer, healthier hearing.
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