Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
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New neurological or vestibular features suggest a complication
Cholesteatoma may erode the structures protecting the facial nerve, inner ear and intracranial contents. A chronically discharging ear can therefore become an emergency.
Action: Arrange immediate hospital ENT assessment for facial weakness, severe vertigo, mastoid swelling, meningism or suspected intracranial infection. Follow the stroke pathway if the wider neurological presentation suggests stroke.
Synopsis
Recognise keratinising middle-ear disease, assess its destructive potential and explain surgical treatment and long-term surveillance without confusing infection control with removal of the lesion.
Cholesteatoma is keratinising squamous tissue in an abnormal middle-ear or mastoid location, not a malignant tumour.
Despite being non-neoplastic, it can erode nearby bone and cause serious complications.
Recurrent offensive discharge and conductive hearing loss are common clues, but neither is present in every case.
Key red flags
Facial weakness or impaired eye closure in a diseased ear requires urgent assessment and attention to corneal protection.
Investigation priorities
01
Specialist otomicroscopy or endoscopic examinationFirst step
Establish the lesion and assess areas hidden during routine otoscopy.
Management branches
Suspicious earRefer while controlling associated infection
Examination suggests retained keratin or a concealed pathological drum pocket.
Arrange ENT assessment with a clear description of the pocket, discharge, hearing symptoms and previous ear surgery.
Use trained cleaning and appropriately selected topical treatment for accompanying infection when indicated, checking membrane integrity and the exact product.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.