Cholesteatoma – Overview Cholesteatoma is a destructive yet non-cancerous growth of skin cells that occurs in the middle ear, behind the eardrum. Although it is not a tumour in the traditional sense, a cholesteatoma can cause serious complications if left untreated. It expands slowly but progressively, damaging the delicate bones of hearing, and in severe cases, spreading into the skull base or brain. Cholesteatomas form when the skin lining of the outer ear canal invades the middle ear space. This often happens due to repeated infections or Eustachian tube dysfunction. When the Eustachian tube (which connects the middle ear to the back of the throat) does not function properly, negative pressure can develop in the middle ear. This pulls the eardrum inward, forming a pocket that traps dead skin and debris. Over time, this pocket expands into a cholesteatoma. There are two main types: congenital cholesteatoma, which is present at birth due to developmental abnormalities, and acquired cholesteatoma, which occurs later in life and is much more common. The acquired type typically affects people with a history of chronic middle ear infections, grommet insertion, or perforated eardrums. Despite being benign, the growth can erode the ossicles (the tiny bones that transmit sound), the mastoid bone, and even reach the inner ear or brain in rare cases. It can cause permanent hearing loss, facial nerve paralysis, dizziness, and life-threatening infections if not treated. For this reason, early diagnosis and surgical removal are critical. Cholesteatoma Cholesteatomas usually affect only one ear, although in rare instances, both ears may be involved. They can affect both children and adults, with slightly higher prevalence in individuals who have poor access to medical care or are immunocompromised. The condition is often identified due to persistent ear discharge, a sense of ear fullness, and progressive hearing loss. Sometimes, more severe symptoms like facial muscle weakness or vertigo may be the first clues to deeper complications. Although cholesteatoma is rare, it is considered serious due to its aggressive nature. Surgical removal is the only effective treatment, and ongoing monitoring is needed to prevent recurrence. Recurrence is possible even after successful surgery, which makes long-term follow-up essential. In summary, cholesteatoma is a dangerous but manageable ear condition that requires surgical treatment. It is not cancerous, but it behaves in a locally invasive way and must be dealt with promptly to avoid long-term damage. [Next: Causes of Cholesteatoma →]