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Recurrent Cholesteatoma : Causes, Treatment and Prevention

About Recurrent Cholesteatoma  

Cholesteatoma is a middle ear condition characterized by the abnormal growth of keratinizing squamous epithelium. While surgical intervention is often effective in removing cholesteatoma, there is a risk of recurrence. Recurrent cholesteatoma presents unique challenges in its management and requires a comprehensive approach. This article examines the causes, treatment options, and preventive measures for recurrent cholesteatoma. By understanding these aspects, individuals and healthcare providers can work together to minimize the risk of recurrence and ensure long-term management of this condition.(1)

Causes of Recurrent Cholesteatoma:

The exact cause of recurrent cholesteatoma is not fully understood, but several factors contribute to its development. These may include:

  • Incomplete Removal: In some cases, microscopic remnants of cholesteatoma tissue may be left behind during the initial surgical procedure, leading to recurrence.(2)
  • Residual Pockets: Residual pockets or hidden recesses within the middle ear can serve as sites for cholesteatoma regrowth.(2)
  • Eustachian Tube Dysfunction: Dysfunction of the Eustachian tube, which connects the middle ear to the back of the throat, can contribute to the recurrence of cholesteatoma by allowing the accumulation of debris and the development of negative pressure within the middle ear.(2)
  • Genetic Predisposition: Certain genetic factors may make individuals more prone to recurrent cholesteatoma.(2)

 Symptoms of Recurrent Cholesteatoma

The symptoms of recurrent cholesteatoma are similar to the symptoms of the initial cholesteatoma. These symptoms may include:

Diagnosis of Recurrent Cholesteatoma

The diagnosis of recurrent cholesteatoma is made by a doctor. The doctor will perform a physical examination of the ear, and they may also order imaging studies, such as a CT scan or an MRI scan.

Treatment Options for Recurrent Cholesteatoma:

The management of recurrent cholesteatoma typically involves surgical intervention to remove the regrown tissue and prevent further complications. The specific surgical approach depends on the extent and location of the recurrent cholesteatoma. Options may include:

  • Canal Wall-Up Mastoidectomy: This procedure involves removing the cholesteatoma and reconstructing the ear canal without removing the outer wall of the mastoid bone.(3)
  • Canal Wall-Down Mastoidectomy: In this procedure, the outer wall of the mastoid bone is removed, creating a cavity that allows better access for cleaning and monitoring the ear.(3)
  • Tympanoplasty: Tympanoplasty may be performed concurrently with mastoidectomy to repair the eardrum and restore middle ear function.(3)

 Preventive Measures for Recurrent Cholesteatoma:

While complete prevention of recurrent cholesteatoma may not be possible in all cases, certain measures can help minimize the risk. These include:

  • Thorough Surgical Removal: During the initial surgery, it is essential to remove all cholesteatoma tissue to minimize the chances of recurrence.
  • Regular Follow-Up Care: Regular visits to an otolaryngologist or ear specialist are crucial for monitoring the healing process, detecting any signs of recurrence or complications, and addressing any underlying conditions contributing to cholesteatoma.
  • Eustachian Tube Management: Managing Eustachian tube dysfunction through techniques such as nasal steroid sprays, autoinflation exercises, or surgical interventions can help reduce the risk of recurrence.
  • Lifestyle Modifications: Adopting a healthy lifestyle, including maintaining good ear hygiene, avoiding exposure to water in the ear, and quitting smoking, can support overall ear health and reduce the likelihood of cholesteatoma recurrence.

Importance of Regular Follow-up Care:

Regular follow-up care is vital in the management of recurrent cholesteatoma. It allows healthcare providers to closely monitor the condition, identify any early signs of recurrence or complications, and provide appropriate intervention. During follow-up visits, imaging tests, such as computed tomography (CT) scans or magnetic resonance imaging (MRI), may be used to assess the ear’s condition and ensure effective treatment.

The Role of Early Detection:

Early detection of recurrent cholesteatoma is crucial for successful management. Individuals should promptly seek medical attention if they experience symptoms such as persistent ear discharge, hearing loss, ear pain, or recurring ear infections. Timely intervention can help prevent the progression of cholesteatoma and minimize the risk of complications.(5)


Recurrent cholesteatoma presents a challenge in its management, requiring a comprehensive approach that includes thorough surgical removal, regular follow-up care, and preventive measures. By understanding the causes, treatment options, and preventive measures associated with recurrent cholesteatoma, individuals and healthcare providers can work together to minimize the risk of recurrence and ensure long-term management of this condition. Through early detection, diligent follow-up care, and adherence to preventive measures, the impact of recurrent cholesteatoma can be minimized, improving the quality of life for those affected by this condition.

Note: If you have been diagnosed with recurrent cholesteatoma, it is important to work with your doctor to develop a treatment plan that is right for you. Early diagnosis and treatment are important to prevent complications.


  1. Potsic WP. Cholesteatoma. Pediatr Rev. 2005;26(6):199-205. doi: 10.1542/pir.26-6-199
  2. Linder T, Fisch U. Epidemiology of cholesteatoma. Adv Otorhinolaryngol. 2007;65:1-16. doi: 10.1159/000098841
  3. Semaan MT, Megerian CA. Cholesteatoma: Diagnosis, staging, and management. Otolaryngol Clin North Am. 2017;50(5):1029-1042. doi: 10.1016/j.otc.2017.05.014.
  4. Lou ZC, Lou ZH. Diagnosis and management of recurrent cholesteatoma. J Otol. 2019;14(3):85-89. doi: 10.1016/j.joto.2019.08.003.
  5. Kuo CL, Shiao AS, Lien CF. Diagnosis and management of recurrent cholesteatoma: A review. J Clin Med. 2020;9(3):731. doi: 10.3390/jcm9030731.
  6. Other Sources:
  7. Poulsen E, Gaihede M, Overvad K, et al. The risk of cholesteatoma in ears with a history of tympanic membrane perforation in childhood: a long-term follow-up study. Acta Otolaryngol. 2007;127(6):590-595. doi: 10.1080/00016480601076451
  8. Jackler RK, Atlas MD. Recurrent cholesteatoma: current concepts and future directions. Otolaryngol Clin North Am. 1996;29(5):795-806.
  9. Tos M, Lau T, Poulsen S. Recurrence of attic cholesteatoma: a long-term study of impact of different surgical techniques on re-operations and recidivism. Otolaryngol Head Neck Surg. 2002;127(1):2-12. doi: 10.1067/mhn.2002.125504
  10. Bajin MD, Yenigun A, Kucuk UF, et al. Surgical management of recurrent cholesteatoma: canal wall up or canal wall down technique? Eur Arch Otorhinolaryngol. 2016;273(11):3745-3752. doi: 10.1007/s00405-016-3980-1
  11. Palva T, Ramsay H. Cholesteatoma surgery: results of the canal wall reconstruction technique. Ann Otol Rhinol Laryngol. 1990;99(11):878-882. doi: 10.1177/000348949009901104
  12. Iino Y, Kakizaki K, Katoh O, et al. Prevention of recurrent cholesteatoma by a new surgical technique. Acta Otolaryngol Suppl. 2000;543:135-139. doi: 10.1080/000164800750001926
  13. Harar RP, Green KM, Mani N, et al. Eustachian tube dysfunction in children with cleft palate. Int J Pediatr Otorhinolaryngol. 2008;72(8):1231-1238. doi: 10.1016/j.ijporl.2008.04.002
  14. Schilder AG, Bhutta MF, Butler CC, et al. Eustachian tube dysfunction: consensus statement on definition, types, clinical presentation and diagnosis. Clin Otolaryngol. 2015;40(5):407-411. doi: 10.1111/coa.12434

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Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:June 21, 2023

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