Children's Hospital Colorado

Cholesteatoma in Children

What is a cholesteatoma?

A cholesteatoma is a cyst in the middle ear space behind the eardrum. It causes inflammation and destruction in the middle ear.

What causes cholesteatoma?

A cholesteatoma can be caused by chronic middle ear infections, injury to the eardrum or eustachian tube dysfunction. Eustachian tube dysfunction is a condition in which the eustachian tube does not work properly. The eustachian tube connects the middle ear to the nose and helps to regulate pressure behind your eardrums. Eustachian tube dysfunction can lead to low pressure. This weakens the eardrum and causes it to pull inward, which causes skin cells and earwax to build up and cause a cholesteatoma.

Rarely, a cholesteatoma may be present at birth (congenital cholesteatoma).

A cholesteatoma cyst can get bigger or become infected, which can damage the surrounding bones within the middle ear.

What are the signs and symptoms of a cholesteatoma?

Your child may have any of the following cholesteatoma symptoms:

  • Hearing loss
  • Drainage from the ear
  • Sensation of fullness or pressure in the ear
  • Dizziness or balance problems
  • Earache
  • Feeling of fullness in the ear

What tests are used to diagnose a cholesteatoma?

  • Physical exam: A physician will examine your child’s ear canal and eardrum.
  • Tympanogram: Our audiologists performs this test to check how easily the eardrum moves. An audiologist is a healthcare professional who specializes in evaluating, diagnosing, treating and managing hearing loss and balance disorders.
  • Audiogram: Our audiologists performs this test to check how well each ear can hear sounds.
  • Auditory brainstem response (ABR): This is a specialized electrophysiologic hearing test that tells how well the inner ear is working. We do an ABR in infants under 3 months of age without sedation. Children older than 3 months will have sedation during the test. Sedation is the use of medicine that help your child relax during a test or procedure. At times, general anesthesia is required. It is only occasionally used in children with a diagnosis of cholesteatoma.
  • Computed tomography scan (CT scan): A CT scan provides images of the bones in the ear. A CT scan can usually be done with no sedation or general anesthesia.
  • Magnetic resonance imaging (MRI scan): An MRI is used to take images soft tissue within the ear. Children under the age of 7 to 8 years may need general anesthesia to complete the study. Occasionally, an MRI scan is ordered before surgery or during a follow-up visit after cholesteatoma surgery.

What can we expect from a cholesteatoma visit?

The clinic visit will take about an hour. This includes check-in, seeing a nurse, and seeing the healthcare provider for history and a physical exam. Your child may also have an audiogram and tympanogram during the same visit. We may recommend further testing and/or treatment at that time.

How is a cholesteatoma treated?

A cholesteatoma is treated with surgery to avoid further damage to the middle ear (bones of the middle ear) and possibly inner ear structures. If damage to the ear is extensive, a cholesteatoma usually requires more than one surgery.

The goal of the first cholesteatoma surgery is to remove the cyst as thoroughly as possible because it can cause damage to the ear and the surrounding area. The surgeon may repair the eardrum and remove one or more of the hearing bones in the middle ear. If the surgeon removes your child’s hearing bones, they will usually reconstruct the bones during a second surgery. This surgery can help to restore any hearing loss.

We also provide any other treatment needed to restore your child's hearing, if needed. Sometimes a hearing aid is needed after surgery.

Why choose Children's Colorado for treatment of your child's cholesteatoma?

Our pediatric otolaryngologists and pediatric audiologists have advanced education and experience in caring for children with chronic diseases of the ear. This expertise enables us to accurately diagnose and treat your child.

We collaborate with our other medical specialists (audiologists, anesthesiologists, CT/MRI technicians, radiologists) who have dedicated their careers to the care of children. This multidisciplinary approach enables us to provide highly specialized care that is tailored to your child's needs.

Helpful resources:

  • ENT Health is a website developed by the American Academy of Otolaryngology-Head and Neck Surgery Foundation. It provides helpful information about cholesteatoma and other conditions that affect the ear.
  • The Vestibular Disorders Association provides more information about the causes, symptoms and treatment of cholesteatoma.