Treatments: Cholesteatoma
How Is Cholesteatoma Treated?
In almost all cases, cholesteatoma is treated by surgical removal. The operation is usually done through or behind the ear under general anesthesia, and often involves removing the diseased mastoid bone cells (a procedure called mastoidectomy).
Surgeons use different approaches depending on how extensive the disease is:
In a "canal wall up" operation, the natural shape of the ear canal is preserved. This gives a more normal-looking, easier-to-manage ear, but there is a somewhat higher chance that cholesteatoma will come back or be left behind, so careful follow-up is essential.
In a "canal wall down" operation, the back wall of the ear canal is removed to create an open cavity. This gives the surgeon a wider view and lowers the chance of the disease returning, but it usually requires lifelong periodic cleaning of the cavity in the office and some water precautions.
Filling in the space left after surgery (mastoid obliteration) and the use of small telescopes during surgery (endoscopic ear surgery) are increasingly used and have been shown to lower the chance of the cholesteatoma returning.
Reconstructing the structures damaged by the cholesteatoma, such as the eardrum (tympanoplasty), the bones of the middle ear (ossiculoplasty, sometimes using a small prosthesis), or the barrier between the cranial vault and the mastoid, may also need to be performed, though this is sometimes done in a separate operation when the surgeon is sure that all of the cholesteatoma has been removed. When hearing cannot be restored by rebuilding the ear bones, a hearing aid — including a bone-anchored hearing device — may be an option.
Follow-Up After Surgery
Because cholesteatoma can regrow or leave microscopic skin cells behind, long-term follow-up is essential even after a successful operation. The risk of recurrence rises over time — estimated at around 7 percent within the first year but as high as roughly 30 to 40 percent over many years — and is generally higher in children, whose disease tends to be more aggressive. Follow-up typically combines periodic ear examinations, hearing tests, and, in many centers, surveillance MRI scans (non-EPI DWI) over a period of at least five years. Any return of ear drainage, hearing loss, dizziness, or facial weakness should be reported promptly.