Cholesteatoma - Symptoms

What type of problem is a cholesteatoma?

Cholesteatoma is an uncommon condition where a cyst-like growth develops in the ear. It can be a birth defect (congenital problem) but usually occurs as a complication of long-standing (chronic) ear infection.


The most common symptoms are loss of hearing and a foul-smelling discharge from the ear. It is not a cancerous (malignant) condition but is important because it can lead to serious complications such as permanent deafness and life-threatening illnesses such as meningitis.

What symptoms does a cholesteatoma cause?

Symptoms start very gradually, over several months.

  • The first symptom is a discharge from one ear. It is usually slightly watery, sometimes with a green or yellow colour.
  • The discharge might be slightly smelly.
  • This often looks to a doctor like an external ear infection (otitis externa) or an infection of the inner ear (otitis media) with a perforated eardrum.
  • Because it looks just like these common infections, it is usually treated (wrongly) with antibiotic ear drops or pills.
  • Although it might get slightly better with these treatments, it will never fully clear up.
  • It is not painful.
  • After a while you may get hearing problems in that ear.
  • If the cholesteatoma is left untreated it can spread into the balance centres of the inner ear, causing dizziness.
  • Eventually, in very rare cases, it can spread right next to the brain and cause an infection in the brain tissue or the lining of the brain. This is very unlikely to happen these days in the western world.

How do we hear?

The ear is divided into three parts - the external ear, the middle ear and the inner ear. The middle ear, which is behind the eardrum (the tympanic membrane) is filled with air. Air comes from the back of the nose up a thin channel called the Eustachian tube. In the middle ear there are three tiny bones (ossicles) - the hammer (malleus), anvil (incus) and stirrup (stapes). The inner ear includes the cochlea and semicircular canals.

Sound waves come into the external ear and hit the eardrum. The sound waves cause the eardrum to vibrate. The sound vibrations pass from the eardrum to the ossicles. The ossicles then transmit the vibrations to the cochlea in the inner ear. The cochlea converts the vibrations to sound signals which are sent down a nerve from the ear to the brain, allowing us to hear.

The semicircular canals in the inner ear contain a fluid that moves around as we move into different positions. The movement of the fluid is sensed by tiny hairs in the semicircular canals which send messages to the brain down the ear nerve to help maintain balance and posture.

detail of middle ear

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Dr Oliver Starr
Peer Reviewer:
Dr Helen Huins
Document ID:
13267 (v4)
Last Checked:
09 May 2017
Next Review:
29 June 2020

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.