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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Assessment online. A doctor can assess the symptoms by video and arrange an ENT referral; the diagnosis and surgery are in person.
- What it is: a benign build-up of skin cells inside the ear, behind the eardrum. It is not a cancer, but it slowly grows and can damage nearby bone.
- Main signs: a watery, smelly discharge from one ear, gradual hearing loss in that ear, and ear infections that keep coming back.
- Treatment: surgery is the only way to remove it. Most people recover fully within 6 to 8 weeks, with long-term check-ups.
- Emergency: call 112 for facial drooping, being unable to lift both arms, slurred speech, confusion, or a severe headache with a stiff neck.
Do not book a video appointment if you have facial drooping, cannot lift both arms and keep them up, have slurred speech, confusion, or a severe headache with a stiff neck: call 112 or go to an emergency department. After ear surgery, heavy discharge or bleeding, a high temperature, or severe or worsening pain needs urgent in-person care: get medical advice the same day.
Can an online doctor help with cholesteatoma?
Partly. A cholesteatoma is diagnosed by an ear specialist, who examines the ear under a microscope and usually arranges a CT scan, and surgery is the only way to remove it. What a doctor by video can do is recognise the pattern that points to it, discharge that does not clear with treatment and hearing that is fading in one ear, check for the warning signs, treat an infection while you wait, and arrange the referral. The doctor can also support you before and after surgery.
How an online consultation helps with possible cholesteatoma
- The pattern recognised: Discharge that keeps coming back after drops, and hearing fading on one side, are taken seriously.
- Warning signs checked first: Facial weakness, dizziness, severe headache or a high temperature mean care in person, promptly.
- The right referral: An ENT specialist, a hearing test and the scan, with a clear summary of your symptoms.
- Support around surgery: Keeping the ear dry, flying, sneezing and blowing your nose, and the signs to watch for.
What the doctor checks in an online assessment for cholesteatoma
The doctor asks about the warning signs first, then about your ear over the past months. The doctor asks about:
- Warning signs: facial weakness, severe dizziness, a severe headache, a stiff neck, confusion or a high temperature.
- The discharge: how long it has lasted, whether it smells, and whether it cleared with the drops or antibiotics you were given.
- Your hearing: gradual hearing loss in one ear, ringing, or a blocked, full feeling.
- Your ear history: repeated ear infections, a hole in the eardrum, grommets, ear injuries and earlier ear surgery.
- After surgery: discharge, bleeding, pain, a high temperature, and how the wound is healing.
Before the call, note how long the discharge has lasted and which treatments you have tried, and have any hearing test or specialist letters to hand.
What is a cholesteatoma? Is it a tumour?
A cholesteatoma is a build-up of dead skin cells in the middle ear, behind the eardrum, that forms a lump or cyst that can look like a pearl. It is a benign growth, not a cancer. It is still a serious problem, because it keeps growing if it is not removed, and enzymes it produces can destroy the nearby bone, including the tiny bones of hearing.
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| Type | How it forms | How common |
|---|---|---|
| Acquired | Usually after a retracted or perforated eardrum, repeated ear infections, an ear injury or ear surgery | The more common type |
| Congenital | Present from birth | Rare; often found in childhood |
What causes a cholesteatoma?
Most cholesteatomas develop when the Eustachian tube, which lets air into the middle ear, does not work well. Low pressure builds behind the eardrum and pulls part of it inwards, forming a pocket that fills with old skin cells. A hole in the eardrum after an infection or an injury, and ear surgery, can also let skin cells collect where they should not. Repeated or long-lasting ear infections raise the risk.
What are the symptoms of cholesteatoma?
A cholesteatoma usually affects one ear. Early on, there may be no symptoms at all. The common symptoms are:
- a watery, smelly discharge from the ear that does not clear fully with treatment
- gradual hearing loss in the affected ear
- ear pain
- a feeling of fullness or pressure in the ear
- ear infections that keep coming back
- dizziness or vertigo, and ringing in the ear (tinnitus)
As it grows, it can cause a high temperature, worsening pain and weakness of the face on the same side, which need prompt care in person.
Cholesteatoma or an ordinary ear infection?
An ear infection usually clears within 3 days to a week. Discharge that smells, lasts for weeks or keeps coming back after antibiotic drops, especially with hearing loss on the same side, needs the ear examined to rule out a cholesteatoma.
How serious is cholesteatoma? Can it kill you?
A cholesteatoma is not a cancer, and with surgery most people do well. Left untreated, it keeps growing and can cause complications. The serious infections in the brain are rare, which is why cholesteatoma is removed rather than watched:
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| Complication | What it means |
|---|---|
| Hearing loss | Damage to the tiny bones of the middle ear or the inner ear |
| Ear infections | Repeated or long-lasting infections and discharge |
| Dizziness and vertigo | Spread of infection to the inner ear |
| Facial weakness | Damage to the facial nerve, which runs through the ear |
| Meningitis or a brain abscess | Rare spread of infection into the skull |
How is cholesteatoma diagnosed?
A family doctor examines inside the ear with an otoscope and may prescribe ear drops if an infection is suspected. Suspected cholesteatoma is referred to an ear, nose and throat (ENT) specialist, who usually arranges:
- an examination of the ear under a microscope, which can show the deposit of skin cells, often with a hole in the eardrum
- hearing tests, including a pressure test of the eardrum (tympanometry)
- a CT scan, to see how far it has spread and whether the bones of hearing are damaged
- sometimes an MRI scan, for example when there is dizziness
What might the doctor recommend for possible cholesteatoma?
What happens next depends on your symptoms and whether you have already been diagnosed. This is the framework the doctors use:
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| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| Facial drooping, slurred speech, confusion, or a severe headache with a stiff neck | Emergency care | No | Call 112 now |
| A discharging ear with new facial weakness, severe dizziness or a high temperature | Urgent assessment | Only to assess | Urgently: get medical advice the same day |
| Smelly discharge that does not clear after antibiotic drops | Treatment of the infection and an ENT referral | Yes, to assess | For examination under a microscope, a hearing test and a CT scan |
| Gradual hearing loss in one ear with ear pain lasting more than 3 days | Assessment and referral | Yes, to assess | For an ear examination and a hearing test |
| Recovering after surgery, healing as expected | Keep the ear dry; advice on flying, sneezing and work | Yes | For your planned follow-up |
| After surgery: heavy discharge, bleeding, a high temperature or worsening pain | Urgent review | Only to assess | Urgently: get medical advice the same day |
Discharge from your ear that keeps coming back? A doctor can tell you in one consultation what needs checking.
See available times →How is cholesteatoma treated?
Surgery is the only way to remove a cholesteatoma. It is done in hospital under a general anaesthetic, and most people go home on the day of the operation or after a night in hospital, longer if there are complications.
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| Step | What happens |
|---|---|
| Removing the cholesteatoma | The surgeon removes the build-up of skin cells from the middle ear |
| Mastoidectomy | Sometimes part of the mastoid bone behind the ear is removed too, if it has spread there |
| Tympanoplasty and reconstruction | The eardrum and middle ear are repaired |
| A second operation | Sometimes planned, to check that none has come back before the hearing bones are reconstructed |
Surgery may improve hearing, but hearing may also stay the same or get worse. Cholesteatoma can come back, so specialists usually advise ear examinations and hearing tests every year for at least 5 years, and sometimes an MRI scan 12 to 18 months after surgery. Regular cleaning of the ear by the specialist may be needed.
Is cholesteatoma surgery a major operation?
It is a planned ear operation under general anaesthetic. Stitches and packing are removed after a few weeks, most people take 1 to 2 weeks or more off work, and most are fully recovered after 6 to 8 weeks.
What you can do yourself
- Get discharge that keeps coming back, or hearing loss in one ear, checked rather than treating it again and again with drops.
- Keep the ear dry: use cotton wool coated in petroleum jelly when you wash your hair, and keep the ear dry in the shower.
- Do not use cotton buds in the ear.
- After surgery, do not swim for at least 6 weeks, keep your mouth open when you sneeze, and do not blow your nose until the surgeon says you can; sniffing is fine.
- Check with your surgeon before flying.
Prescription treatment
A prescription is never issued without a consultation. No medicine removes a cholesteatoma. If the ear is infected, the doctor may prescribe antibiotic ear drops or tablets to treat the infection while you wait for the specialist, and may advise on pain relief after surgery. Strong opioid painkillers are never prescribed online. If the doctor prescribes, use the prescription at a pharmacy near you.
What does not help
Repeated courses of drops for discharge that never fully clears, without an ear examination. Cotton buds. Swimming or getting water in the ear while it is discharging or healing.
Special situations
Repeated ear infections or a hole in the eardrum
Prompt and thorough treatment of long-lasting ear infections may help prevent a cholesteatoma. A hole in the eardrum that has not healed is one of the routes to it, so it needs follow-up. The perforated eardrum page explains healing.
Eustachian tube problems
A Eustachian tube that does not let air into the middle ear can pull the eardrum inwards over time. The Eustachian tube dysfunction page covers the symptoms and what helps.
Mastoiditis
Rarely, a cholesteatoma blocks drainage from the middle ear and leads to an infection of the bone behind the ear. Swelling, redness or tenderness behind the ear needs care in person promptly; the mastoiditis page explains the signs.
Cholesteatoma while travelling in Europe
Before travelling after surgery, check with your surgeon about flying and swimming, and keep a copy of your operation note. If the ear starts discharging heavily or bleeding, or you develop a high temperature, see a doctor promptly.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When cholesteatoma is assessed online, and when you need in-person care
Assessed online: discharge that keeps coming back and hearing loss in one ear, the warning signs, treatment of an infection while you wait, the ENT referral, and support before and after surgery.
In-person care: the examination under a microscope, hearing tests, CT and MRI scans, surgery and follow-up checks, and any emergency sign.
When to get in-person care
Call 112 or go to an emergency department now for:
- facial drooping on one side, or being unable to lift both arms and keep them up
- slurred or garbled speech, or confusion
- a severe headache with a stiff neck, a rash or sensitivity to light
- a seizure
Get medical advice the same day for:
- new weakness of the face on the side of a discharging ear
- severe dizziness or a high temperature with ear discharge
- heavy discharge or bleeding from the ear or the wound after surgery
- severe or worsening ear pain
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about your ear: say how long the discharge has lasted, which treatments you have tried, and how your hearing has changed, and mention any earlier ear surgery.
- Leave with a plan: what to do, what to take and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s cholesteatoma? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Ear infection can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about cholesteatoma
What is a cholesteatoma?
A cholesteatoma is a build-up of dead skin cells in the middle ear, behind the eardrum, that forms a lump or cyst. It causes smelly discharge, hearing loss and repeated infections, and it is removed with surgery.
Is a cholesteatoma a tumour or cancer?
A cholesteatoma is a benign growth, not a cancer. It is still serious because it keeps growing if it is not removed and can destroy the nearby bone.
How serious is cholesteatoma?
Left untreated, a cholesteatoma can cause hearing loss, repeated infections, dizziness and weakness of the face, and rarely meningitis or a brain abscess. With surgery, most people do well.
Can cholesteatoma kill you?
Very rarely, an untreated cholesteatoma lets infection spread into the skull, causing meningitis or a brain abscess. That is why it is removed with surgery rather than watched.
What causes a cholesteatoma?
Most cholesteatomas develop when the Eustachian tube does not work well: low pressure pulls part of the eardrum inwards into a pocket that fills with skin cells. A hole in the eardrum, repeated ear infections, injuries and ear surgery can also lead to one. A few are present from birth.
What are the first signs of a cholesteatoma?
Often there are no signs of a cholesteatoma at first. Then a watery, smelly discharge from one ear that does not clear fully with treatment, and gradual hearing loss in that ear, are the most common signs.
Is cholesteatoma surgery a major operation?
Cholesteatoma surgery is a planned ear operation under general anaesthetic. Most people go home on the day of the operation or the next day, take 1 to 2 weeks or more off work, and are fully recovered after 6 to 8 weeks.
Can a cholesteatoma come back after surgery?
Yes, a cholesteatoma can come back. That is why specialists advise ear examinations and hearing tests every year for at least 5 years, sometimes with an MRI scan or a planned second operation.
What is the outlook after cholesteatoma surgery?
Good for most people: the cholesteatoma is removed, the discharge stops and the ear becomes safe, and most people are fully recovered 6 to 8 weeks after the operation. Hearing depends on how much damage the cholesteatoma had already done; the tiny bones of hearing can sometimes be repaired, in the same operation or a later one. Because it can come back, yearly ear checks and hearing tests continue for at least 5 years, sometimes with an MRI scan.
Can a cholesteatoma be treated without surgery?
No. Surgery is the only way to remove it. Antibiotic drops or tablets can treat an infection around it, but they do not remove the cholesteatoma.
What can I do at home while waiting for cholesteatoma treatment?
Keep the ear dry: no swimming, and keep water out in the shower with a cotton wool ball coated in petroleum jelly; do not put cotton buds or drops into the ear unless a doctor has prescribed them; and take paracetamol or ibuprofen for pain. Note how often the discharge happens, because that helps the specialist, and get advice without delay for a high temperature, severe pain, facial weakness or sudden dizziness, which can mean the cholesteatoma has caused an infection or complication.
Can a cholesteatoma be prevented?
Not always, because some cholesteatomas are present from birth, but most develop after years of Eustachian tube problems and repeated middle ear infections, so treating ear infections properly, getting glue ear and a retracted eardrum checked, and not ignoring an ear that keeps discharging all lower the risk. The most important step is early diagnosis: a cholesteatoma found while it is small is removed with a simpler operation and less damage to hearing.
Can I fly after cholesteatoma surgery?
Check with your surgeon before flying after cholesteatoma surgery. Keep the ear dry, do not swim for at least 6 weeks, and do not blow your nose until the surgeon says you can.
Can an online doctor help with cholesteatoma?
Partly. A doctor can assess the symptoms of a possible cholesteatoma by video, treat an infection, arrange the ENT referral and support you before and after surgery. The diagnosis, scans and surgery are in person.
- Cholesteatoma, NHS, National Health Service (UK), reviewed 20 February 2025.
- Cholesteatoma, Cleveland Clinic (US), reviewed 13 February 2024.
- Cholesteatoma, MedlinePlus, US National Library of Medicine, reviewed 29 April 2026.
- Cholesteatoma, MSD Manual Consumer Version, reviewed June 2026.
- Ruptured eardrum (perforated eardrum): symptoms and causes, Mayo Clinic (US), 2025.
- Ear infections, NHS, National Health Service (UK), reviewed 16 January 2025.
- Mastoiditis, Cleveland Clinic (US), reviewed 18 January 2025.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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