Cholesteatoma, not a tumor, but also dangerous: Four people came into the consultation room at once, three of them young men, who sat down with the old man with a nervous look. One of the older men said to me, “My father’s ears have been running for several years, and the day before yesterday we took him to the doctor, who said he had cholesteatoma and needed surgery. My father has worked hard all his life to live a good life, but he has a tumor again! Doctor, is this tumor curable?” I asked the patient about his condition in detail, gave him an otoscopic examination, and reviewed the CT film they brought to me. I told the family my initial diagnosis: cholesteatoma is not a true tumor, but a cystic structure. It is a cystic structure filled with shed epithelium and keratinized material as well as cholesterol crystals, hence the name cholesteatoma. Although cholesteatoma is not a true tumor, it can be dangerous. Not only can it directly compress the surrounding bone, but it can also produce a variety of enzymes and substances such as prostaglandins, which can decalcify the surrounding bone and destroy the bone wall. While the middle ear is in the temporal bone, it is surrounded by important structures such as the cranial brain, facial nerve, cochlea, and jugular vein, etc. If the bone of the middle ear is destroyed, the lesion can spread to the above structures, thus causing serious complications such as facial paralysis, sensorineural deafness, meningitis, and brain abscess. Cholesteatoma of the middle ear, which must be operated on: “How is that going to be treated?” Several children asked in unison. “It must be treated surgically, and it is better to operate as early as possible.” I said clearly. The purpose of surgery is threefold: (1) to completely remove the diseased tissue, including the cholesteatoma, sarcoid, diseased bone and mucosa; (2) to preserve the original hearing or increase it; and (3) to obtain a dry ear (keep the ear dry and clean) as much as possible. Depending on the purpose, surgery can be divided into two main categories: mastoid radical surgery, which aims to clean up the middle ear lesions, and tympanoplasty, which aims to reconstruct the sound-transmitting structures of the middle ear and improve hearing. However, the choice of the specific surgical procedure should be decided based on specific conditions such as the extent of the lesion, the functional status of the eustachian tube, and the type and degree of hearing impairment. “With the current medical technology, the results of treatment for middle ear cholesteatoma are still very satisfactory.” I added. Hearing, not all can be improved: “Then my dad wants to have surgery to improve his hearing!” The oldest son stated firmly. “Every patient and family wants a tympanoplasty to preserve or improve hearing, but patients with lesions so severe that sometimes only a radical mastoid surgery is possible. In addition, even if some patients can undergo tympanoplasty, the destruction of the original sound-transmitting structures such as tympanic membrane and auditory tuberosity, or the poor air content of the cavity or mucosal scar formation can make the postoperative hearing improvement unsatisfactory. Therefore, as family members and patients, they should be treated correctly and sensibly.” I cautioned. Be alert to middle ear cholesteatoma if: ① there is mostly persistent ear overflow, but it can also manifest as intermittent flow. ②The discharge is purulent or mucopurulent, and may contain bean residue-like material with a foul odor. ③ Hearing loss, and it is mostly mixed deafness or sensorineural deafness. ④Specialist examination revealed that the tympanic membrane perforation were in the relaxed part or the posterior superior edge of the tense part; through the perforation, grayish-white scaly or bean residue-like material was seen in the tympanic chamber. ⑤ CT examination of the temporal bone suggested bone destruction with sharp edges. ⑥Extracranial complications such as postauricular abscess and fistula, neck abscess, facial nerve palsy, etc. have been present; and/or intracranial complications such as meningitis, brain abscess, hydrocephalus, sigmoid sinus thrombophlebitis, etc. have been present.