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

Updated: Jan 21, 2015

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 be
delivered to the center of the cholesteatoma. Topical antibiotics often surround a
cholesteatoma, suppress infection, and penetrate a few millimeters toward its
center; however, a large, infected cholesteatoma is resistant to any type of
antimicrobial therapy. Consequently, otorrhea either persists or recurs, despite
frequent and aggressive treatment with antibiotics.
Hearing loss
Hearing loss is also a common symptom
of cholesteatomas. Large cholesteatomas fill the middle ear space with
desquamated epithelium, with or without associated mucopurulent discharge,
interfering with sound transmission. Ossicular damage is frequently present and
can 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 the
previous image.

A study by Yehudai et al of 124 pediatric patients with chronic otitis media,

without or without cholesteatoma, found a significant association between the
presence of cholesteatoma in this disease and the degree of sensorineural hearing
loss at 2000 Hz.[12]
Dizziness is a relatively uncommon symptom of cholesteatomas, but it does
occur if bony erosion produces a labyrinthine fistula or if the cholesteatoma is
lying directly on the footplate of the stapes. Dizziness is a worrisome symptom
because it may presage the development of more serious complications.
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 these
individuals were also determined to be at somewhat increased risk. Persons with
a cleft lip, however, were found not to have a higher cholesteatoma risk. The
historical cohort study included 8593 persons with a nonsyndromic orofacial cleft,

converted by

as well as 6989 siblings.[14]

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