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The middle ear is an air-filled cavity which is sealed by the eardrum and contains the chain of three small bones called the malleus (hammer), incus ( anvil) and stapes (stirrup). The Eustachian tube connects the middle ear to the back of the nose and ventilates it. The mastoid bone lies behind the ear and is an air reservoir connected to the middle ear.

If the ear drum becomes very stretched it can collapse into the middle ear and form a ‘retraction pocket’. Sometimes these pockets can grow deeper into the ear and mastoid and erode some of the structures involved in hearing and balance. This condition is termed cholesteatoma and surgery may be necessary to remove it.

In the early stages the pocket may be easily removed and the ear drum repaired as a tympanoplasty. When the pocket extends into the mastoid bone removal of this portion may require the creation of a small cavity or may be carried out as a ‘combined approach tympanoplasty’ to preserve the canal wall. Sometimes a ‘second look’ is necessary up to a year later to ensure the cholesteatoma has been removed completely.

Surgery has been helped by the improvements in operating microscopes and sometimes the KTP laser is used to ensure full removal of the cholesteatoma. Otoendoscopes (small telescopes) can help visualise some of the more inaccessible recesses of the middle ear and mastoid.

Click to download information booklet: Cholesteatoma



The North Hampshire ENT Partnership is a team of consultants specialising in a wide spectrum of diseases and disorders that affect the Ear, Nose & Throat (ENT) including snoring and sleep disorders, cosmetic and skin surgery.


Our surgeons provide specialist care by drawing from the 50 plus years of combined NHS experience and the many areas of individual specialist expertise available within the partnership.


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