What is a cholesteatoma?

A cholesteatoma is a sac of dead skin cells that 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.

What are the benefits?

The aim is to remove the cholesteatoma and stop the discharge. It may be possible to improve your hearing at the same time.

Are there any alternatives?

Surgery is the only way to remove the cholesteatoma.

Regular cleaning and antibiotics will help to keep any unpleasant-smelling discharge or infection under control.

What will happen if I decide not to have the procedure?

The cholesteatoma will continue to grow and may damage the bones in and near your ear.

The cholesteatoma can damage the small bone plate that separates your ear from your brain, causing a brain abscess or meningitis.

Infection can spread to the mastoid bone, causing mastoiditis. Infection can also spread to your neck, causing a neck abscess.

What does the procedure involve?

The procedure is performed under a general anaesthetic and usually takes 2 to 3 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.

How can I prepare myself for the procedure?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help you prepare for the procedure, help you recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you may need to reduce your risk of serious illness while you recover.

What complications can occur?

The healthcare team are trained to reduce the risk of complications.

Any risk rates given are taken from studies of people who have had this procedure. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, have other health problems or you smoke. Health problems include diabetes, heart disease or lung disease.

Possible complications of this procedure are shown below. Some can be serious and may even cause death.

General complications of any procedure

• Bleeding during or after the procedure.
• Infection of the surgical site (wound) which may cause the graft to fail.
• Allergic reaction to the equipment, materials or medication.
• Venous thromboembolism (VTE). This is a blood clot in your leg (deep-vein thrombosis – DVT) or one that has moved to your lung (pulmonary embolus).
• Chest infection. Your risk will be lower if you have stopped smoking and you are free of COVID-19. (coronavirus) symptoms for at least 7 weeks before the procedure.

Complications specific to this procedure

• Hearing loss, which may be total and permanent.
• Numbness of your ear. This usually gets better within 3 months.
• Damage to the facial nerve. Your surgeon will use a device called a facial nerve monitor to minimise this risk.
• Change of taste.
• Dizziness.
• Tinnitus (ringing in your ear).
• Ear discharge. Even after the cavity has healed, you may continue to get an ear discharge from time to time.
• Allergic reaction, which results in pain, swelling and discharge from your ear and may also cause the graft to fail.
• Some cholesteatoma being left behind.

Consequences of this procedure

• Pain.
• Scarring of your skin, which can be unsightly.

What happens after the procedure?

You should be able to go home the next day.

You should be able to return to work after about 3 weeks.

If your surgeon needed to shape your mastoid bone into a cavity, you will probably need to come back to the clinic several times in the first few months until the cavity has healed completely.

Protect your ear from water, using cotton wool and Vaseline, and do not swim until your surgeon has told you that your ear has healed.

Regular exercise should help you to return to normal activities sooner. Before you start exercising, ask the healthcare team or your GP for advice.

Most people make a good recovery. However, if the bone of your ear canal was not removed, some cholesteatoma may be left behind.

Summary

A cholesteatoma can damage your ear and cause serious complications. Surgery is the only way you can be cured.

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