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Author: Peter S Roland, MD; Chief Editor: Arlen D Meyers, MD, MBA more...

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Painless otorrhea

The hallmark symptom of a cholesteatoma is a painless otorrhea, either unremitting or frequently recurrent. When the cholesteatoma becomes infected,the infection may be extremely difficult to eradicate.

Because the cholesteatoma has no blood supply, systemic antibiotics cannot bedelivered to the center of the cholesteatoma. Topical antibiotics often surround acholesteatoma, suppress infection, and penetrate a few millimeters toward itscenter; however, a large, infected cholesteatoma is resistant to any type of antimicrobial therapy. Consequently, otorrhea either persists or recurs, despitefrequent and aggressive treatment with antibiotics.

Hearing loss

Hearing loss is also a common symptomof cholesteatomas. Large cholesteatomas fill the middle ear space withdesquamated epithelium, with or without associated mucopurulent discharge,interfering with sound transmission. Ossicular damage is frequently present andcan also produce or may magnify a conductive loss. (See the image below.)

 A large epitympanic (attic) cholesteatoma that is much more advanced than the lesion in theprevious image.

 A study by Yehudai et al of 124 pediatric patients with chronic otitis media,without or without cholesteatoma, found a significant association between thepresence of cholesteatoma in this disease and the degree of sensorineural hearing

loss at 2000 Hz.[12]

Dizziness

Dizziness is a relatively uncommon symptom of cholesteatomas, but it doesoccur if bony erosion produces a labyrinthine fistula or if the cholesteatoma islying directly on the footplate of the stapes. Dizziness is a worrisome symptombecause it may presage the development of more serious complications.

Other 

Occasionally, cholesteatoma initially presents with symptoms of CNS

complications, sigmoid sinus thrombosis,[13] epidural abscess, or meningitis.

 A Danish study indicated that in persons with a cleft palate, the risk of cholesteatoma is 20-fold that of the general population; siblings of theseindividuals were also determined to be at somewhat increased risk. Persons witha cleft lip, however, were found not to have a higher cholesteatoma risk. Thehistorical cohort study included 8593 persons with a nonsyndromic orofacial cleft,

 

Updated: Jan 21, 2015

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as well as 6989 siblings.[14]

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