Cholesteatoma surgery carries real risks, but it is not considered a dangerous operation. The most common complication, surgical site infection, occurs in roughly 4.5% of cases. Serious complications like facial nerve injury or total hearing loss are rare, and the risks of leaving a cholesteatoma untreated are substantially worse than the risks of removing it.
The Most Common Surgical Risks
The complication that comes up most often after cholesteatoma surgery is a wound infection at the surgical site. In a study of 336 cholesteatoma operations, 15 patients (4.5%) developed an infection, typically appearing within about 8 days of surgery. These infections were treated with antibiotics and resolved. Interestingly, giving preventive antibiotics before or after surgery didn’t appear to reduce that rate.
Temporary taste changes are also common and often catch patients off guard. Surgery in the middle ear can disturb a small nerve that runs through the area and contributes to taste sensation. About 43% of patients notice some change in taste within the first 10 days, most often a dulled sense of flavor or a metallic taste. This drops to around 23% at four months and settles to about 9% by one year. Most people recover fully.
Some dizziness after surgery is normal. In patients who had vertigo before and after the procedure, recovery typically took anywhere from a few weeks to about four months, with balance tests returning to normal in that window. Permanent vestibular damage from the surgery itself is uncommon.
Facial Nerve Injury
This is the risk that worries most patients, and understandably so. The facial nerve runs directly through the area where surgeons operate, controlling movement on that side of the face. In first-time ear surgeries, the rate of facial nerve injury has been reported at 1% to 4%. For revision surgeries, where scar tissue and altered anatomy make the landscape harder to navigate, the risk roughly doubles to somewhere between 4% and 10%.
Many of these injuries are temporary palsies that resolve over weeks or months, not permanent paralysis. In one series of 90 operations for chronic ear disease (85% involving cholesteatoma), there were zero cases of permanent facial paralysis caused by the surgery itself. Surgeons use landmarks, imaging, and sometimes nerve monitoring to track the nerve throughout the procedure.
What Happens to Your Hearing
Cholesteatoma usually damages the tiny bones in the middle ear before you ever reach the operating room, so most patients already have significant hearing loss going in. Surgery aims to remove the disease first and improve hearing second, sometimes in a staged approach.
In a long-term study of 124 ears, about 84% were considered successfully treated from a hearing standpoint, meaning the gap between bone conduction (inner ear function) and air conduction (overall hearing) was brought to a reasonable level. Nearly half of all ears saw inner ear function actually improve slightly after surgery, and no cases of inner ear damage were recorded. Total deafness in the operated ear is a recognized possible complication listed in surgical consent forms, but it is rare when the inner ear is not already compromised by the cholesteatoma itself.
The practical reality is that many patients hear better after surgery than before it, though some need a hearing aid afterward, particularly if the middle ear bones had to be removed and couldn’t be reconstructed in the same operation.
Rare but Serious Complications
Cerebrospinal fluid leak, where the thin bone separating the ear from the brain lining is breached, occurs in a small percentage of cases. Reported rates range from about 3% to 20% depending on the complexity of the surgery and the extent of the disease. When it happens, surgeons typically repair it during the same operation using a small muscle graft, and outcomes are generally good.
Brain abscess and meningitis from the surgery itself are extremely rare. As for general anesthesia, the estimated mortality risk is about 1 in 100,000 for surgical inpatients, with the lowest risk in children aged 5 to 14.
Recurrence: The Long Game
One risk that isn’t about danger in the operating room but matters enormously is the chance the cholesteatoma comes back. Recurrence rates vary widely depending on the surgical technique and patient age. In adults, five-year recurrence runs between 12% and 20% depending on the approach. In children, that number jumps significantly, reaching 37% overall and as high as 58% with certain techniques.
This is why many surgeons plan a second-look surgery, typically 9 to 12 months after the first, to check for residual disease. In a review of nearly 1,250 patients, about one-third of planned second-look surgeries found residual cholesteatoma. That means two-thirds of those follow-up operations turned out to be unnecessary, but there’s currently no perfect way to predict who still has disease without going in or using specialized imaging. The trend is shifting toward MRI surveillance as an alternative to routine second-look surgery, though practice varies.
What Happens Without Surgery
The strongest argument for surgery is what a cholesteatoma does if you leave it alone. It is a growth that slowly erodes bone, and it does not stop on its own. Over time, it destroys the hearing bones, can eat into the inner ear causing permanent deafness and chronic vertigo, and can erode the bone protecting the brain.
Untreated cholesteatoma can lead to meningitis in a striking 35% to 46% of cases according to imaging-based reviews. Between 1% and 5% of inadequately treated patients develop serious brain complications including abscess. It can also cause facial nerve paralysis, sigmoid sinus blood clots, and cerebrospinal fluid leaks on its own, without any surgical intervention. In other words, the very complications people fear from surgery are the same ones the disease causes if left unchecked, and at higher rates.
Cholesteatoma surgery is not risk-free, but it is a well-established procedure where the most common complications are manageable infections and temporary taste changes. The serious risks, while real, are uncommon and far less likely than the serious consequences of doing nothing.