Cholesteatoma: Symptoms, Causes and Treatments

This growth behind the eardrum can damage your hearing if it’s left untreated

Stephanie Watson,

AARP

Reviewed by

Bria Collins, Au.D.

Comments

Published September 03, 2025

shattered head and ear concept illustration

Rob Dobi

Key takeaways:

Cholesteatoma is a cyst that forms in the middle ear from a retracted or ruptured eardrum or a pocket of dead skin cells.
The cause of cholesteatoma in adults isn’t well understood, but it’s likely connected to eustachian tube dysfunction.
Cholesteatoma symptoms include hearing loss in one ear, a feeling of fullness in the affected ear and fluid drainage out of that ear.
Treatment involves surgery to remove the cholesteatoma and sometimes rebuilding the eardrum and hearing bones.

If you struggle to hear conversations and need subtitles to follow your favorite TV shows, the cause of your hearing loss could be age — but not always. Hearing loss, especially when it affects only one ear and is accompanied by a feeling of fullness or pressure in that ear, can also be a symptom of cholesteatoma, a cyst in the middle ear.

Though cholesteatoma isn’t very common, it can be serious if you don’t manage it appropriately. Getting a prompt diagnosis and the right treatment could help you avoid serious complications such as permanent hearing loss and damage to the nerves of your face.

What is cholesteatoma?

A cholesteatoma is a benign cyst that forms in your middle ear, the part of the ear that transmits sound vibrations from your eardrum to your inner ear.

A cholesteatoma begins as a small pocket of skin cells in the middle ear. If it’s left untreated, it collects more skin and debris over time — like a snowball picking up more snow — so it keeps getting larger.

“As those dead skin cells accumulate in the pocket … the cyst gets bigger and bigger and bigger, and it erodes everything in its way,” says Bradley Kesser, M.D., a professor and vice chair of the otolaryngology department at the University of Virginia School of Medicine.

Untreated cholesteatoma can damage bones, soft tissues and nerves in your middle ear. That damage could lead to hearing loss, balance issues, weakness in the face and changes to your sense of taste.

What causes cholesteatoma?

Cholesteatoma usually forms after a chronic ear infection in children, but what causes it in adults isn’t as clear. “People can develop cholesteatoma in their 40s, 50s and 60s, and we just don’t know why that happens,” Kesser says. “We still haven’t made a whole lot of progress in understanding why it forms.”

One possibility is that an upper respiratory infection or sinusitis leads to eustachian tube dysfunction. The eustachian tube is a passageway that connects your nose and throat to the middle ear and helps regulate pressure in the ear. When your eustachian tube isn’t working correctly, negative pressure builds in your inner ear and forces the eardrum to pull inward.

Cholesteatoma symptoms

To help you identify whether you have one of these cysts, watch for cholesteatoma ear symptoms like:

Gradual hearing loss in the affected ear
A feeling of fullness in the affected ear
Drainage of fluid, sometimes foul-smelling, from the ear
Vertigo — a sensation where, for example, the room is spinning
Tinnitus — a ringing, humming or hissing sound in the ear
Weakness in the face

It’s common to have hearing trouble as you get older, but hearing loss caused by a cholesteatoma is unique. “If there is a difference in hearing between the two ears — you’ve got one good ear and one not so good ear — that should really prompt you to seek medical attention,” Kesser says.

How doctors diagnose cholesteatoma

Start with a visit to your primary care doctor, who will look in your ear and prescribe drops or antibiotics if they suspect an infection. If your symptoms don’t improve, they’ll likely send you to an otolaryngologist (an ear, nose and throat doctor, or ENT). Or you can go directly to an ENT if your insurance allows it.

The ENT will use a microscope to look more closely inside your ear. “Under our microscope, we can see that this isn’t, for example, a hole or a routine infection that’s going to resolve with antibiotics,” says David S. Haynes, M.D., a professor of otolaryngology and chief patient experience officer at Vanderbilt University Medical Center.

Free Hearing Test

AARP members can take the National Hearing Test online or on their phones — for free. This 10-minute test can help you decide whether you need a more comprehensive hearing exam.

If you notice hearing loss in one ear, your doctor will likely order a hearing test by a licensed audiologist to find out how severe it is. The audiologist will perform a series of tests to measure your outer, middle and inner ear and identify which part of your ears is causing the hearing loss.

If you have a cholesteatoma, it’s common to have conductive hearing loss because the growth blocks sound from traveling efficiently through the middle ear. Additionally, your doctor may order a computed tomography (CT) scan, which can show the size and extent of the cholesteatoma.

Cholesteatoma treatment options

In the early stages when the eardrum starts to retract, an ENT might try to alleviate the negative pressure and prevent cholesteatoma by placing a tube in your ear or prescribing a nasal spray to help your eustachian tube work better.

“If a patient is smoking, we’ll encourage them to stop smoking. That helps,” Haynes says. Smoking is linked to eustachian tube dysfunction.

Once a cyst filled with dead skin cells forms, it almost always needs surgery. Otherwise, as it grows the cyst will damage structures in your ear.

“It almost always causes hearing loss and drainage,” Haynes says. “Advanced forms can cause facial weakness and dizziness and erosion of the brain lining.”

There are a few surgical procedures to remove a cholesteatoma and repair your eardrum and middle ear space, including a mastoidectomy. Your doctor will determine which treatment is right for you based on the size of your cholesteatoma.

For example, if you have a large cholesteatoma removed, your surgeon may need to reconstruct your eardrum using cartilage taken from another part of your ear in a procedure called tympanoplasty.

“This gives the eardrum strength and support so that it doesn’t collapse back into the middle ear again,” Kesser says.

Any hearing bones that have been damaged are reconstructed using prosthetics made from titanium. Ideally, you’ll be able to have a tympanomastoidectomy, which combines a mastoidectomy and tympanoplasty in one surgery.

Cholesteatoma surgery takes three to four hours, or longer if you have damage to hearing bones or to other tissues inside your ear.

The cholesteatoma surgery recovery takes around one to three weeks. Your doctor will recommend that you avoid strenuous exercise and swimming until you’ve fully recovered.

Surgery leaves behind a scar, but the cholesteatoma surgery scar is usually small and easily concealed behind your ear and hair. One concern after the procedure is that the cholesteatoma will come back. If even one skin cell is left behind, it can eventually grow into a new cyst. Your ENT and audiologist will recommend regular follow-ups to recheck your hearing and look for symptoms of a recurrence, such as drainage from your ear.

Bottom line

A cholesteatoma may not be severely bothersome at first, but it does need prompt attention. Without treatment, it can continue to grow and damage the delicate structures inside your ear, leading to serious complications.

You could be left with permanent hearing loss, vertigo or facial weakness. Even meningitis is possible if the cyst damages the bone that separates your inner ear from your brain. So if you notice hearing loss, drainage or a feeling of fullness in one ear, the best plan of action is to see your primary care doctor or an ENT for a workup.

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Stephanie Watson is a freelance writer with more than two decades of experience covering consumer health. Her work has appeared in WebMD, Time, Harvard Health Publications, Healthline, HealthCentral and many other publications. She also served as executive editor of Harvard Women’s Health Watch.

Bria R. Collins is an associate director of audiology practices at the American Speech-Language-Hearing Association. She has more than 10 years of clinical experience as an audiologist, including at the Veterans Affairs Medical Center in Washington, D.C., where she evaluated military service members with hearing and balance concerns.