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Cholesteatoma in children

Glenn C Isaacson, MD, FAAP
Section Editor
Anna H Messner, MD
Deputy Editor
Carrie Armsby, MD, MPH


A cholesteatoma (sometimes called a keratoma) is an abnormal growth of squamous epithelium in the middle ear and mastoid [1,2]. It may progressively enlarge to surround and destroy the ossicles, resulting in conductive hearing loss. Hearing loss also may occur if the cholesteatoma obstructs the eustachian tube orifice, leading to middle ear effusion. Surgical therapy is required for most cholesteatomas. The extent and effectiveness of surgery depends upon the size of the cholesteatoma [3]. Early diagnosis is crucial to an optimal outcome [4,5].

The clinical features and treatment of cholesteatomas in children will be reviewed here. Other complications of otitis media are discussed separately. (See "Acute otitis media in children: Epidemiology, microbiology, clinical manifestations, and complications", section on 'Complications and sequelae'.)


Cholesteatoma – A cholesteatoma is an abnormal accumulation of squamous epithelium within the middle ear and mastoid.

Congenital cholesteatoma – The classic definition of a congenital cholesteatoma is a cholesteatoma that develops behind an intact tympanic membrane (TM) in a child with no history of middle ear disease (picture 1) [6]. However, since most children have some history of middle ear disease during infancy, cholesteatomas are considered to be congenital if they occur in children who have an intact TM and no history of ear surgery [4,7,8].

Acquired cholesteatoma – Acquired cholesteatomas develop after birth, usually as a result of chronic middle ear disease.

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Literature review current through: Nov 2017. | This topic last updated: Aug 17, 2016.
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