Cholesteatoma in Tanzania: Symptoms, Causes & Treatment | aihealz
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Cholesteatoma.Care & specialists in Tanzania
In Tanzania, cholesteatoma is managed by ents. Cholesteatoma is an abnormal, expansile collection of keratinizing squamous epithelium within the middle ear or mastoid cavity that gradually erodes surrounding bone. Annual incidence in adults is roughly 9 per 100,000 (Tos 1988); pediatric incidence about 3 per 100,000, with bilateral disease in 10-15% of children.
aliases · Cholesteatoma (middle ear skin cyst)· Middle ear skin cyst· Pearl tumor· Colesteatoma· reviewed May 14, 2026
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Reviewed by AIHealz Medical Editorial Board · ENTLast reviewed May 13, 2026
Cholesteatoma (ICD-10: H71) is a destructive epithelial cyst within the middle ear cleft (tympanic cavity, attic, antrum, mastoid air cells) lined by keratinizing stratified squamous epithelium. The lesion is not a true neoplasm but produces matrix expansion, periostitis, and bone erosion through release of osteolytic cytokines (IL-1, IL-6, TNF-alpha, RANKL) by the perimatrix. Cholesteatomas are classified by the EAONO/JOS 2017 consensus as congenital (white pearl behind an intact eardrum with no history of otorrhea or eardrum surgery) or acquired, with acquired forms subdivided into primary acquired (retraction-pocket-derived, most commonly Prussak's space or pars flaccida) and secondary acquired (following tympanic-membrane perforation, trauma, or post-surgical implantation). Stage is assigned by anatomic extent and reflects surgical complexity and prognosis: Stage I (limited to one site, attic or mesotympanum), Stage II (two or more sites), Stage III (extracranial complications such as labyrinthine fistula or facial nerve involvement), and Stage IV (intracranial complications).
key facts
Prevalence
Annual incidence approximately 9 per 100,000 adults and 3 per 100,000 children (Tos 1988; Kemppainen 1999); cumulative lifetime prevalence about 0.1%
Demographics
Slight male predominance (1.4:1); peaks at age 5-15 (acquired pediatric) and 30-50 (acquired adult); congenital cholesteatoma typically detected age 2-10
Avg. age
Pediatric acquired: 8-12 years; adult acquired: 30-50; congenital: 4 years on average
Global cases
Roughly 1 in 1,000 ENT consultations is for cholesteatoma; significantly higher prevalence in low-resource regions with untreated chronic suppurative otitis media
Specialist
ENT
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How you might notice it
The key symptoms of Cholesteatoma are: Chronic, foul-smelling otorrhea that does not respond to repeated courses of antibiotics — the hallmark complaint, present in 60-80% of acquired cases., Progressive conductive hearing loss of 20-40 dB caused by ossicular erosion (typically incus long process and stapes superstructure)., Retraction pocket or perforation in the pars flaccida or posterior-superior quadrant visible at otoscopy, often containing white keratin debris., White pearl visible behind an intact tympanic membrane on otoscopy in congenital cholesteatoma, classically in the anterior-superior quadrant in children age 2-10., Ear fullness, pressure, and intermittent dull pain in chronic disease; severe pain is uncommon and suggests complication., Vertigo or imbalance, particularly with Valsalva maneuver or pressure changes — pneumatic-otoscopy-induced vertigo (positive fistula test) suggests labyrinthine fistula., Facial weakness ranging from subtle asymmetry to House-Brackmann grade III-VI palsy when the lesion erodes the fallopian canal..
01Chronic, foul-smelling otorrhea that does not respond to repeated courses of antibiotics — the hallmark complaint, present in 60-80% of acquired cases.
02Progressive conductive hearing loss of 20-40 dB caused by ossicular erosion (typically incus long process and stapes superstructure).
03Retraction pocket or perforation in the pars flaccida or posterior-superior quadrant visible at otoscopy, often containing white keratin debris.
04White pearl visible behind an intact tympanic membrane on otoscopy in congenital cholesteatoma, classically in the anterior-superior quadrant in children age 2-10.
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How it’s diagnosed
diagnosis
Diagnosis combines clinical otoscopic examination with audiometry and selected imaging. Microsuction with a binocular operating microscope or oto-endoscope is the cornerstone of clinical assessment: removal of keratin debris and granulation tissue exposes the retraction pocket, perforation, or pearl. Documented findings include site (pars flaccida attic, pars tensa, posterior-superior, anterior-superior), extent (limited or extensive), bone erosion, and any visible middle-ear structures (ossicles, facial canal). Pure-tone audiometry quantifies conductive, mixed, or rarely sensorineural hearing loss and informs ossicular reconstruction planning. Imaging is required preoperatively for all cases. Non-contrast high-resolution CT of the temporal bones (0.6 mm slices) maps anatomy: tegmen tympani thickness, sigmoid sinus position, facial canal integrity, scutum erosion, ossicular continuity, lateral semicircular canal fistula, and mastoid pneumatization. CT identifies bony erosion patterns but cannot reliably distinguish granulation tissue from cholesteatoma matrix. Non-echo-planar diffusion-weighted MRI is the modern standard for distinguishing cholesteatoma from inflammation: cholesteatomas show restricted diffusion (bright on b1000) due to densely packed keratin, with sensitivity 90% and specificity 95% for lesions over 3 mm (De Foer 2008). This imaging has reduced the need for routine second-look surgery in many centers. Pneumatic otoscopy and the fistula test (positive vertigo or nystagmus with pressure changes) suggest labyrinthine fistula. Facial nerve function is documented with House-Brackmann grading. In children, examination under anesthesia may be required.
Key tests
01
Otomicroscopy or oto-endoscopy with microsuctionDirect visualization of retraction pocket, perforation, keratin debris, and middle-ear structures after clearance of obstructing material
02
Pure-tone and speech audiometryQuantifies conductive, mixed, or sensorineural hearing loss; informs ossicular reconstruction planning and counseling on outcome
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Treatment & cost
medical treatments
✓Topical ciprofloxacin-dexamethasone ear drops
✓Office microsuction with aural toilet
✓Oral antibiotics for superimposed infection
surgical options
Canal-wall-up (CWU) tympanomastoidectomyDisease-free ear in 60-80% at 5 years; recurrence 20-40% in extensive disease; 5-15 dB conductive hearing gain after ossiculoplasty
Canal-wall-down (CWD) mastoidectomyDisease-free ear in 85-95% at 5 years; recurrence 5-15%; lifelong cavity care required; hearing reconstruction more challenging
Modified CWD with mastoid obliterationDisease-free ear in 85-95% with smaller residual cavity; selected patients return to swimming with caution
Endoscopic transcanal ear surgeryComplete removal in selected disease in 80-95%; recurrence 10-20% at 3-5 years in published series
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Causes & risk factors
known causes
Eustachian tube dysfunction
Persistent negative middle-ear pressure from poor eustachian tube ventilation pulls the pars flaccida or posterior quadrant of the tympanic membrane into the attic, creating a retraction pocket. The pocket cannot self-clean and accumulates keratin that progressively expands. This is the dominant mechanism in 60-70% of acquired cases.
Chronic middle ear inflammation
Recurrent acute otitis media and chronic otitis media with effusion in childhood damage the middle-ear mucosa, weaken the tympanic membrane, and predispose to retraction. Cleft palate and craniofacial syndromes confer especially high lifetime risk.
Tympanic membrane perforation
Squamous epithelium of the external canal migrates inward through a marginal perforation (especially posterior-superior) to colonize the middle ear in secondary acquired cholesteatoma. Persistent perforations after acute otitis media or trauma should be repaired to prevent this complication.
Embryonic epithelial rests
Congenital cholesteatomas arise from epithelial rests trapped in the middle ear during fetal development, classically in the anterior-superior quadrant near the eustachian tube orifice (Michaels 1986 hypothesis). They present in children 2-10 years with no history of otorrhea.
Iatrogenic implantation
Squamous epithelium can be implanted into the middle ear during tympanostomy tube insertion, tympanoplasty, or mastoidectomy if technique is suboptimal. Iatrogenic cholesteatoma typically presents 2-10 years post-procedure and is often well-defined.
Genetic susceptibility
Family history of cholesteatoma raises personal risk 5-10 fold; sibling and parent-child concordance suggest a multifactorial heritable component. Bilateral disease in children, in particular, warrants assessment of craniofacial anatomy and family screening.
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Living with it
01Treat acute otitis media promptly and ensure full resolution; address chronic middle-ear effusion with tympanostomy tubes when indicated.
02Repair persistent or large tympanic membrane perforations in adolescents and adults with tympanoplasty.
03Monitor children with cleft palate, Down syndrome, and other craniofacial anomalies with periodic otoscopy and audiometry from age 1 onward.
04Avoid unsupervised cotton-bud or instrumental cleaning of the ear canal, which can perforate the eardrum and seed squamous epithelium.
05Implement universal newborn hearing screening and follow-up audiology to detect early conductive losses indicating eustachian-tube dysfunction.
06Ensure timely otolaryngology referral for any retraction pocket noted on routine otoscopy.
recommended foods
•Balanced diet supporting general immune function during recovery
•Adequate hydration (1.5-2 L water daily) particularly after surgery
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When to seek help
why see an ent
Cholesteatoma requires evaluation by an otologist or general otolaryngologist with cholesteatoma surgical volume. The diagnosis is made in clinic but management is operative; delay risks ossicular destruction, hearing loss, facial nerve injury, and intracranial complications. Pediatric cases benefit from a pediatric otolaryngology service. Recurrent or extensive disease, only-hearing ear, and skull-base involvement need a neurotologist at a tertiary center.
01Hearing loss — conductive loss from ossicular erosion or sensorineural loss from labyrinthine fistula or surgical injury (sensorineural injury below 5% in modern series).
02Facial nerve palsy — preoperative from disease (1-2%), intraoperative iatrogenic injury (under 1% with monitoring).
03Labyrinthine fistula at the lateral semicircular canal in 5-10% of advanced cases; risks sensorineural hearing loss and vertigo.
Primary acquired cholesteatoma (retraction pocket)Most common form (60-70% of all cholesteatomas). Eustachian tube dysfunction creates persistent negative middle-ear pressure that retracts the tympanic membrane, most commonly at Prussak's space in the attic. Keratin accumulates in the retraction pocket and progresses to expansile disease.
Secondary acquired cholesteatomaDevelops after tympanic membrane perforation, trauma, or otologic surgery. Squamous epithelium migrates inward from the external auditory canal margins through the perforation. Accounts for 15-25% of cases.
Congenital cholesteatomaPresent at birth from embryonic epithelial rests; presents in children age 2-10 as a white pearl behind an intact eardrum, classically in the anterior-superior quadrant. No prior otorrhea or eardrum surgery. Accounts for 2-5% of cholesteatomas.
Petrous apex cholesteatomaRare, often congenital cholesteatoma of the petrous portion of the temporal bone. Presents with facial palsy, retrobulbar pain, or sixth-nerve palsy from cavernous sinus involvement rather than otorrhea. Requires lateral or anterior petrosectomy.
Mural (canal-wall) cholesteatomaSquamous epithelium growing on the external auditory canal wall, often with bone erosion (keratosis obturans variant). Can mimic neoplasm and requires biopsy if confused with malignant otitis externa or carcinoma.
Living with Cholesteatoma
Timeline
Postoperative discharge usually next day for simple tympanoplasty, 1-2 days after mastoidectomy. Outer dressing removal and gentle ear cleaning at 2 weeks. Audiogram at 6-8 weeks. Graft take confirmed at 6 weeks. Hearing improvement evident from 8-12 weeks and stabilizes by 6 months. Canal-wall-down cavity-care visits every 6-12 months; canal-wall-up DWI surveillance at 12 and 24 months. Second-look ossiculoplasty, when planned, performed 6-12 months after primary surgery.
Lifestyle
01Keep the ear dry during showering and washing — use a vaseline-coated cotton plug or commercial earplugs.
02Avoid swimming and diving in untreated water; chlorinated pool swimming after surgery requires surgeon clearance.
03Do not insert cotton buds, hairpins, or other objects into the ear canal.
04Use prescribed ear drops as directed and complete the full course.
05Attend regular postoperative follow-up — recurrent cholesteatoma is detected most reliably at scheduled review or non-EPI DWI scanning.
01Inspect the ear for discharge or unusual smell; report changes
Choosing a doctor
Choose an otologist performing at least 40 mastoidectomy and tympanoplasty procedures per year, with access to non-EPI DWI MRI surveillance and high-resolution temporal bone CT. Pediatric cases benefit from surgeons trained in both pediatric and otologic surgery. Endoscopic ear surgery experience is desirable for limited attic disease. Multidisciplinary cleft and craniofacial teams improve outcomes in patients with cleft palate.
Cholesteatoma is an abnormal skin-like growth in the middle ear that gradually erodes the small bones of hearing and surrounding structures. It usually develops from a retraction pocket caused by long-standing eustachian tube dysfunction. The only effective treatment is surgical removal.
What are the symptoms of cholesteatoma?▾▴
Typical symptoms include chronic, foul-smelling ear discharge that does not respond to antibiotics, gradually worsening hearing in the affected ear, ear fullness, and occasional dizziness. Severe pain, facial weakness, severe headache, or fever indicate complications requiring urgent assessment.
Is cholesteatoma a cancer?▾▴
No. Cholesteatoma is not a cancer or malignant tumor. It is an abnormal but benign collection of skin cells inside the middle ear. However, it grows progressively, destroys nearby bone, and can cause serious complications if left untreated.
How is cholesteatoma diagnosed?▾▴
Diagnosis is made by an ENT specialist using a binocular microscope or endoscope to inspect the ear canal and middle ear. Hearing tests, high-resolution CT of the temporal bones, and non-echo-planar diffusion-weighted MRI confirm the diagnosis, map anatomy, and guide surgical planning.
Can cholesteatoma be treated without surgery?▾▴
No. Surgery is the only definitive treatment for cholesteatoma. Antibiotic ear drops and microsuction provide temporary relief from discharge but do not eradicate the disease. Untreated cholesteatoma progresses and can cause serious complications including hearing loss and meningitis.
What is tympanomastoidectomy?▾▴
Tympanomastoidectomy is the surgical removal of cholesteatoma combined with mastoidectomy and repair of the eardrum. It can be performed canal-wall-up (preserving normal anatomy) or canal-wall-down (creating an open cavity), depending on disease extent and recurrence risk.
What is the difference between canal-wall-up and canal-wall-down surgery?▾▴
Canal-wall-up preserves the natural ear canal wall, maintains anatomy and better hearing potential but has higher recurrence (20-40%). Canal-wall-down removes the wall, creating an open mastoid cavity with lower recurrence (5-15%) but requires lifelong cavity care and water precautions.
Can cholesteatoma come back after surgery?▾▴
Yes. Recurrent or residual disease occurs in 20-40% of canal-wall-up procedures and 5-15% of canal-wall-down procedures. Pediatric rates are higher. Surveillance with non-EPI diffusion-weighted MRI at 12 and 24 months or planned second-look surgery detects recurrence early.
Will my hearing improve after cholesteatoma surgery?▾▴
Hearing improvement depends on ossicular damage at the time of surgery. With ossicular reconstruction, 50-70% of patients achieve an air-bone gap within 20 dB at 1 year. Severely damaged ossicles may need a TORP prosthesis or bone-conduction hearing aid. Some patients still require amplification afterwards.
Can cholesteatoma cause facial paralysis?▾▴
Yes. Erosion of the facial nerve canal by the cholesteatoma can produce partial or complete facial weakness in 1-2% of cases. This requires urgent surgical removal and decompression. Recovery to grade I-II House-Brackmann function occurs in 70-85% when treated within 2 weeks of onset.
Are children at higher risk of cholesteatoma?▾▴
Children with recurrent ear infections, cleft palate, Down syndrome, and other craniofacial anomalies have higher risk. Pediatric cholesteatoma also tends to grow faster and recur more often than adult disease, with 15-40% recurrence after surgery. Bilateral disease occurs in 10-15% of children.
What is congenital cholesteatoma?▾▴
Congenital cholesteatoma is present from birth and arises from embryonic epithelial rests trapped in the middle ear. It is typically detected age 2-10 as a white pearl behind an intact eardrum, classically in the anterior-superior quadrant. It accounts for 2-5% of cases.
Can cholesteatoma cause meningitis?▾▴
Yes. Erosion of the tegmen tympani allows infection to spread intracranially, causing meningitis, brain abscess, or lateral sinus thrombosis in 1-5% of advanced disease. Symptoms include fever, severe headache, neck stiffness, and altered consciousness — these require emergency assessment.
How long does cholesteatoma surgery take?▾▴
Tympanomastoidectomy typically takes 2-4 hours under general anesthesia, depending on disease extent. Endoscopic transcanal surgery for limited disease may be shorter (1-2 hours). Most adults go home the same day or the next morning; children may stay overnight for observation.
Can I fly after cholesteatoma surgery?▾▴
Most surgeons allow short-haul flights at 2-4 weeks after surgery and long-haul flights at 4-6 weeks, once the eardrum graft has healed. Pressure changes during ascent and descent can disturb early healing. Always confirm with your surgical team before booking travel.
Is endoscopic ear surgery suitable for cholesteatoma?▾▴
Yes. Endoscopic ear surgery is increasingly used for limited attic and mesotympanic disease, avoiding the postauricular incision and mastoidectomy in 30-50% of carefully selected adult cases. Results are comparable to microscopic surgery in suitable patients.
Can I swim with a cholesteatoma?▾▴
Swimming with active cholesteatoma is discouraged because water entry worsens discharge and infection. After canal-wall-down surgery, water precautions are lifelong unless the cavity is fully epithelialized. Custom swim plugs can allow chlorinated pool swimming in selected patients.
What is non-EPI diffusion-weighted MRI?▾▴
Non-echo-planar diffusion-weighted MRI is a specialized scan that distinguishes cholesteatoma matrix from inflammation by detecting restricted water diffusion in densely packed keratin. Sensitivity is 90% and specificity 95% for lesions over 3 mm, and it can replace routine second-look surgery in many cases.
Does cholesteatoma run in families?▾▴
Family history raises personal risk approximately 5-10 fold. A multifactorial heritable component combines with eustachian tube anatomy and childhood infection patterns. Siblings of pediatric cases, especially bilateral disease, warrant otoscopy and audiometry to screen for early disease.
Can cholesteatoma be prevented?▾▴
Some risk factors are modifiable. Prompt treatment of acute otitis media, addressing chronic middle-ear effusion with grommets, repairing persistent eardrum perforations, monitoring children with cleft palate and Down syndrome, and avoiding cotton-bud cleaning of ears reduce risk.
How long does follow-up last after cholesteatoma surgery?▾▴
Follow-up is essentially lifelong because recurrent or residual disease can appear years after apparently successful surgery. Canal-wall-up patients have non-EPI DWI scans at 12 and 24 months; canal-wall-down patients have cavity-care appointments every 6-12 months indefinitely.
05Ear fullness, pressure, and intermittent dull pain in chronic disease; severe pain is uncommon and suggests complication.
06Vertigo or imbalance, particularly with Valsalva maneuver or pressure changes — pneumatic-otoscopy-induced vertigo (positive fistula test) suggests labyrinthine fistula.
07Facial weakness ranging from subtle asymmetry to House-Brackmann grade III-VI palsy when the lesion erodes the fallopian canal.
08Tinnitus, often pulsatile when adjacent to the sigmoid sinus or due to ossicular fixation.
09Headache, fever, photophobia, neck stiffness, or altered consciousness — red-flag features suggesting intracranial complication (meningitis, abscess, sinus thrombosis).
10Discharge that recurs after each grommet (tympanostomy tube) placement in children should raise concern for underlying cholesteatoma.
early warning signs
•Recurrent ear discharge despite appropriate antibiotic and aural toilet care
•Persistent or deepening retraction pocket in the pars flaccida or posterior-superior quadrant on follow-up otoscopy
•Conductive hearing loss greater than expected for a simple tympanic membrane perforation
•White debris visible in a retraction pocket or behind an intact tympanic membrane
•New tinnitus, episodic vertigo, or unilateral hearing loss in a patient with known chronic otitis media
● emergency signs
•Acute facial nerve palsy in a patient with chronic ear disease — emergency surgical decompression within 24-48 hours
•Fever, severe headache, neck stiffness, photophobia, or altered mental status — exclude bacterial meningitis or intracranial abscess with urgent CT and lumbar puncture
•New onset vertigo with sensorineural hearing loss — labyrinthine fistula requires urgent imaging and surgical assessment
•Postauricular swelling, fluctuance, or fistula — Bezold abscess, subperiosteal abscess, or mastoiditis requires drainage and intravenous antibiotics
•Seizure, focal neurological deficit, or papilledema in a patient with chronic otorrhea — exclude lateral sinus thrombosis or brain abscess with contrast MRI
Non-echo-planar diffusion-weighted MRI (non-EPI DWI)Distinguishes cholesteatoma matrix (restricted diffusion, bright on b1000) from granulation tissue with 90% sensitivity, 95% specificity for lesions over 3 mm
05
TympanometryAssesses tympanic membrane mobility and middle-ear pressure; type B or C tracings support effusion or retraction
06
Fistula testProvokes pressure-induced vertigo or nystagmus when a labyrinthine fistula is present
07
Examination under anesthesia (children)Permits adequate microsuction and assessment in children unable to tolerate office examination
Outlook
Complete surgical removal at the primary procedure leads to a disease-free, dry ear in 60-85% of adult patients and 50-75% of pediatric patients at 5 years. Hearing outcomes depend on ossicular status at time of surgery and reconstruction method: closure of the air-bone gap to within 20 dB is achieved in 50-70% of cases with PORP and 30-50% with TORP. Recurrence rates differ by approach: 20-40% with canal-wall-up versus 5-15% with canal-wall-down; pediatric recurrence rates are higher because of faster epithelial growth and more aggressive disease. Facial palsy resolves to House-Brackmann grade I-II in 70-85% of cases when surgery occurs within 2 weeks of onset. Intracranial complications occur in under 1% of treated cases in high-income countries but remain substantially more common in low-resource settings with untreated disease. Lifelong follow-up is required because recurrent or residual disease can present years after apparently complete surgery.
risk factors
Recurrent acute otitis media in childhoodmodifiable
Three or more episodes of acute otitis media in 12 months doubles cholesteatoma risk over a lifetime. Prompt antibiotic treatment and tympanostomy tubes in children with persistent middle-ear effusion reduce long-term sequelae.
Eustachian tube dysfunctionnon-modifiable
Chronic eustachian tube dysfunction underlies most retraction-pocket cholesteatomas. Cleft palate raises lifetime risk approximately 7-fold; Down syndrome and other craniofacial anomalies are similarly affected.
Cleft palate or craniofacial anomaliesnon-modifiable
Cleft palate confers a 7-9 fold higher lifetime cholesteatoma risk through eustachian tube dysfunction. Aggressive otologic surveillance and early grommet placement are recommended in affected children.
Previous tympanic membrane perforation or otologic surgerymodifiable
Marginal or large perforations and previous tympanostomy tube placement increase secondary acquired cholesteatoma risk. Tympanoplasty for symptomatic perforations is recommended in adolescents and adults.
Family history of cholesteatomagenetic
Sibling or parent with cholesteatoma increases personal risk 5-10 fold. Assessment of first-degree relatives is recommended in pediatric and adolescent cases, particularly bilateral disease.
Male sexnon-modifiable
Approximately 1.4 male-to-female prevalence ratio in most series. Reasons unclear; possibly related to eustachian tube anatomy and childhood otitis media patterns.
Low socioeconomic status and limited healthcare accessenvironmental
Untreated chronic suppurative otitis media in low-resource settings increases secondary cholesteatoma incidence substantially. WHO estimates 65-330 million people globally have chronic suppurative otitis media.
•
Iron-rich foods if surgical blood loss has caused mild anemia
•Adequate protein intake (1-1.2 g/kg/day) during postoperative recovery
foods to avoid
•Tobacco smoking — impairs middle-ear mucosa and wound healing
•Heavy alcohol intake during postoperative recovery
•Allergens that trigger upper respiratory inflammation in known atopic patients
•Decongestant-only ear-drying remedies marketed online with unverified ingredients
06
Cavity problems: chronic discharge, granulation, deep cleaning needs, water restrictions, and hearing aid fitting difficulty in canal-wall-down ears.
07Failure of ossicular reconstruction with persistent conductive hearing loss in 30-50% of cases requiring revision or hearing aid use.
choosing the right hospital
01Otology and neurotology service with cholesteatoma volume above 100 cases per year
02Pediatric otolaryngology team for paediatric cases
04High-resolution temporal bone CT with 0.6 mm slices
05Intraoperative facial nerve monitoring
06Audiology service for pre- and post-operative testing
07Endoscopic ear surgery instrumentation
08Skull-base team for intracranial complications
Essential facilities
Tertiary otology and neurotology centersPediatric otolaryngology programsSkull-base surgery teamsHearing rehabilitation services including bone-conduction implantsMultidisciplinary cleft and craniofacial clinics
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02
Apply prescribed ear drops at the right angle to reach the middle ear
03Keep the ear dry until cleared by the surgeon
04Use a hearing aid or bone-conduction device when prescribed for residual loss
05Attend cavity-care appointments every 6-12 months in canal-wall-down patients
06Have non-EPI DWI MRI at 12 and 24 months after canal-wall-up surgery
Exercise
Resume light activity within 1-2 weeks of surgery. Avoid heavy lifting, straining, and contact sports for 4-6 weeks while the graft heals. Air travel is generally allowed after 2-4 weeks at the surgeon's discretion. Scuba diving requires individualized assessment by an otologist — most patients with prior cholesteatoma are advised against deep diving because of barotrauma risk and the presence of a mastoid cavity.