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A cholesteatoma is an abnormal skin growth that occurs in the middle ear behind the eardrum. Cholesteatomas often develop as cysts or pouches that shed layers of old skin which build up inside the middle ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear leading to hearing loss. In rare cases, a cholesteatoma can cause permanent hearing loss, dizziness, and facial muscle paralysis if left untreated.

Frequently, a cholesteatoma is caused by poor eustachian tube function as well as an infection in the middle ear. The eustachian tube sends air from the back of the nose into the middle ear to equalize ear pressure. When the eustachian tubes work poorly, sometimes due to allergies, a cold, or sinusitis, the air in the middle ear is absorbed by the body, creating a partial vacuum in the ear. The vacuum pressure creates a pouch or sac by stretching the eardrum, especially areas weakened by previous infections, and this can develop into a cholesteatoma. A rare form of cholesteatoma present at birth can occur in the middle ear and elsewhere, such as in the nearby skull bones. However, the type of cholesteatoma associated with ear infections is most common.

An examination by an ENT practitioner can confirm the presence of a cholesteatoma. Initial treatment may consist of careful cleaning of the ear, antibiotics, and ear drops. Therapy aims to stop drainage in the ear by controlling the infection. The growth traits of a cholesteatoma must also be evaluated.

A large or complicated cholesteatoma usually requires surgery to protect the patient from serious complications. Hearing and balance tests and CT scans may be necessary. These tests are performed to determine the hearing level in the ear and the extent of damage the cholesteatoma has caused.