What is Cholesteatoma surgery?


Know the basics

What is Cholesteatoma surgery?

A cholesteatoma is where a sack of dead skin cells forms in a pocket in your middle ear. The cholesteatoma will slowly get larger and eventually fill your middle ear and mastoid bone. The cholesteatoma can cause an unpleasant-smelling discharge and loss of hearing.

Why is Cholesteatoma surgery performed?

Usually only one ear is affected by a cholesteatoma. The two most common symptoms are:

  • Persistent, often smelly, discharge from the affected ear;
  • Gradual loss of hearing in the affected ear.

Some people may also experience some minor discomfort or a feeling of fullness in their ear.

If your GP thinks you have a cholesteatoma, they will refer you to hospital so your ear can be examined by an ear, nose and throat (ENT) surgeon.

Understand the risks

What are the risks of Cholesteatoma surgery?

Life-long follow-up is required, as cholesteatomas may recur, especially congenital ones. Regular facial nerve monitoring is gradually being replaced by testing for selected cases only (e.g., revision surgery, previous facial nerve weakness). Cholesteatoma remains an important cause of permanent, moderate conductive hearing loss.

The risks of surgery are similar to those of leaving the cholesteatoma untreated, such as hearing loss, tinnitus and vertigo, but generally the benefits of removing the cholesteatoma far outweigh the risks. You should discuss the risks with your surgeon.

All but the first of the complications listed below are rare (of the order of about 1% or less).

  • Temporary (few months) alteration of taste;
  • Perichondritis;
  • Chondritis;
  • Ear canal stenosis;
  • Facial nerve injury;
  • Formation of a fistula into one of the semicircular canals;
  • Labyrinthine or middle-ear injury leading to long-term dizziness;
  • Acquired cholesteatoma following surgery for congenital cholesteatoma has been reported.

You should know that there are some alternative to this treatment:

  • Regular cleaning and antibiotics will help to keep any unpleasant-smelling discharge or infection under control.
  • Medical therapy is reserved for those patients who refuse surgery or for whom a general anaesthetic would be too dangerous owing to comorbidity. In these patients, regular ear cleaning with treatment of infections (topical ± systemic antibiotics) is advised but, ultimately, this will not prevent cholesteatoma growth with its consequences.

It is important you understand the risks and complications before having this surgery. If you have any questions, please consult with your doctor or surgeon for more information.

Know what happens

How do I prepare for Cholesteatoma surgery?

To confirm that you have a cholesteatoma, an ENT surgeon will re-examine your ear and may carry out some hearing tests. You may also have a computerized tomography (CT) scan to see which parts of your ear are affected.

The operation is performed under a general anaesthetic. You must discuss to your doctor about your recent medications, your allergies or any of your health conditions and before having an operation, you will meet your anaesthetist and plan your anaesthetic together. It’s important to follow the instructions about when to stop eating and drinking prior to surgery.

What happens during Cholesteatoma surgery?

The operation usually takes between two to three hours.

Your surgeon will make a cut in front of or behind your ear. They will remove bone from around the cholesteatoma to see where it has spread to, and remove it.

Your surgeon may need to remove the bone of your ear canal. If this happens, they will shape the bone behind your ear (mastoid bone) into a cavity that opens into your ear and make a graft for your eardrum.

If you have any questions or concerns, please consult with your doctor or surgeon for more information.


What happens after Cholesteatoma surgery?

You will often need to stay in hospital at least overnight after the operation, and you should plan to take a week or two off work. Your surgeon can advise you about this.

When you get home, take care to keep the operated ear dry. You should be able to wash your hair after a week, provided you do not get water inside the ear. This can be avoided by plugging the ear with cotton wool coated with Vaseline.

Swimming, strenuous activities and sports may need to be avoided for a few weeks. Check with your surgeon at your follow-up appointment when it is safe to resume these.

Your surgeon may also recommend avoiding flying for several weeks after surgery. Again, you can ask them about this at your follow-up appointment.

Hello Health Group does not provide medical advice, diagnosis or treatment.


Review Date: January 1, 2017 | Last Modified: September 6, 2018

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