Fiducia TogetherCholesteatoma
Skin growing in the middle ear, eroding bone as it goes. A long-standing smelly discharging ear is not something to live with.
Important: This page is general information, not medical advice, and it is not a diagnosis. If you are worried about your health or someone else's, speak to a GP, pharmacist, or call 111. In an emergency, call 999.
What it is
An abnormal collection of skin cells growing in the middle ear behind the eardrum. It is not a tumour, but it behaves destructively: it expands, and it erodes the bone around it.
That erosion is what makes it important. It can destroy the tiny hearing bones causing permanent hearing loss, damage the balance organ causing vertigo, damage the facial nerve causing facial weakness, and erode into the skull causing meningitis or a brain abscess.
It usually develops from long-standing eustachian tube problems, often after years of glue ear or repeated ear infections, and sometimes after a perforated eardrum.
**The classic presentation is an ear that has discharged for months or years, with a persistent offensive smell, and a hearing loss on that side.** People commonly accept this as their normal ear, and use drops from a pharmacy for years. It is not normal, and it will not resolve.
The only treatment is surgery to remove it. Antibiotics and drops settle the infection temporarily and do nothing about the underlying growth.
It recurs in a proportion of cases, so long-term follow-up or a planned second operation is standard.
Signs you might notice
Persistent or recurrent discharge from one ear, often smelly, sometimes scanty.
Gradual hearing loss on that side.
A feeling of fullness or pressure in the ear.
Earache.
Later, and needing urgent assessment: vertigo or dizziness; facial weakness on that side; severe headache; neck stiffness; fever; or confusion.
999 or A and E: headache, fever, neck stiffness, confusion or drowsiness with a discharging ear.
**Any ear that has discharged for more than a few weeks needs ENT assessment**, not repeated courses of drops.
How it can affect day-to-day life
The years of acceptance are the theme. People manage a smelly discharging ear with tissue, cotton wool and pharmacy drops, and never mention it, until hearing loss or dizziness forces the issue.
Water must be kept out of the ear, which affects showering, hair washing and swimming, and proper ear plugs or moulds are worth getting rather than improvising.
Surgery ranges from a limited procedure to a mastoidectomy, and hearing may be reconstructed at the same time or in a second operation.
After a mastoidectomy with an open cavity, regular cleaning at an ENT clinic is needed for life, typically every six to twelve months, and dropping out of that follow-up leads to recurrent problems.
Hearing loss after surgery is common and hearing aids should be offered rather than waited for.
For children, cholesteatoma is more aggressive and recurrence is more likely, so follow-up is longer.
Supporting someone well
Do not accept a long-standing discharging ear. Ask for ENT referral.
Do not treat it indefinitely with pharmacy drops.
Keep water out of the ear, using proper plugs or a swim mould.
Get vertigo, facial weakness or severe headache with a discharging ear seen urgently.
Attend the cavity-cleaning appointments after surgery, for life if that is what is advised.
Ask for a hearing test after surgery, and for hearing aids if needed.
Ask about the plan for a second-look operation, which is standard in many cases.
For a child, expect longer follow-up and ask about the recurrence risk.
Where to read more
Last reviewed 2026-08-28 by Fiducia Together · Next review due 2027-08-28
Important: This page is general information, not medical advice, and it is not a diagnosis. If you are worried about your health or someone else's, speak to a GP, pharmacist, or call 111. In an emergency, call 999.