Concierge otology · London
Cholesteatoma surgery in London, by a consultant otologist.
A proper microsurgical operation for cholesteatoma — canal wall up or canal wall down, tympanoplasty and ossiculoplasty as needed, with hearing preservation on the agenda from the first consultation.
Why patients choose us
- 01
A consultant otologist, in theatre
A named ear surgeon with subspecialty otology training — not a general ENT list — operating in a proper microsurgical theatre.
- 02
Hearing preservation on the agenda
Canal wall up, ossiculoplasty and endoscopic ear surgery discussed honestly against disease clearance — the two goals held in balance from the first consultation.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private cholesteatoma surgery costs in London.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across the imaging, the audiology and the operation itself.
In short
A canal wall up mastoidectomy with tympanoplasty in our network: £7,500–£12,000, one night stay.
| Procedure | Indicative range | Typical duration | Stay |
|---|---|---|---|
| Consultation with consultant otologist | £250–£450 | 30–45 min | Same visit |
| HRCT temporal bones | £450–£800 | 10 min | 24–48h report |
| MRI non-EPI diffusion (DWI) for cholesteatoma | £650–£1,100 | 30 min | 24–48h report |
| Pure-tone audiometry and tympanometry | £120–£220 | 30 min | Same visit |
| Canal wall up mastoidectomy and tympanoplasty | £7,500–£12,000 | 2–3 h GA | 1 night stay |
| Canal wall down mastoidectomy | £8,500–£13,500 | 3–4 h GA | 1–2 night stay |
| Second-look mastoid exploration | £5,500–£9,000 | 2 h GA | 1 night stay |
| Endoscopic ear surgery (limited disease) | £6,000–£10,000 | 1.5–2 h GA | Day case |
Prices vary by hospital, by which otologist does the case, by the extent of disease found in theatre, and by whether ossicular reconstruction is done as a first or second stage. We come back with a firm quote within one working day.
The problem
A dedicated otologist, the right imaging, an honest hearing plan.
Cholesteatoma is not a bread-and-butter ENT case — it needs an ear surgeon who does mastoids weekly, HRCT and MRI DWI read by a temporal-bone radiologist, and a candid conversation about hearing before any operation is booked.
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Not sure it is a cholesteatoma?
Microscopic examination, microsuction and imaging confirm the diagnosis before anything else — no operation is booked on a hunch.
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Worried about your hearing?
An audiogram before surgery, an honest quote of the numbers, and a plan for reconstruction — one-stage or staged.
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Want disease cleared properly?
A named consultant otologist, facial nerve monitoring, and MRI DWI or a second-look operation planned in from the start.
The journey
From enquiry to surveillance — what happens, in order.
One clinician from first message to second-look — including the surveillance imaging.
Phase 1 · Before your operation
Concierge, off-stage for you
Phase 2 · On the day
One night at the hospital
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. Ear discharge, hearing loss, dizziness, any previous ear surgery, and whether an HRCT or MRI has already been done.
- 02
Before
We come back with a recommendation
Within one working day: the right otologist, whether HRCT temporal bones or MRI DWI is needed first, and an indicative price for the imaging and the surgery.
- 03
Before
We arrange the appointment
Otoscopy and microsuction at the first visit, imaging arranged if not yet done, and a pure-tone audiogram before any operation is booked.
- 04
On the day
Arrival at the hospital
Admission, consent and a chat with the otologist and anaesthetist. Cholesteatoma surgery is done under general anaesthetic in a microsurgical theatre.
- 05
On the day
The operation itself
Two to four hours in theatre — atticotomy, canal wall up or canal wall down mastoidectomy, tympanoplasty and ossiculoplasty as needed, with facial nerve monitoring throughout.
- 06
On the day
Overnight, usually
Most patients stay one night. A head bandage overnight, ear pack in place, and simple painkillers. Discharge the next morning with written aftercare.
- 07
After
Recovery, audiogram and second look
Ear pack out at two to three weeks, audiogram at three months, and — for canal wall up cases — MRI DWI or planned second-look surgery at nine to twelve months to check for residual disease.
Typical end-to-end: 3–4 weeks from enquiry to operation. Surveillance: 9–12 months to MRI DWI or second look.
When it helps
When cholesteatoma surgery is the right step.
The presentations we see most, the imaging findings that confirm it, and the red flag that means A&E rather than a clinic booking.
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Chronic smelly ear discharge
Persistent, foul-smelling otorrhoea that does not settle with drops — the classic presentation, and a strong pointer to cholesteatoma.
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Progressive conductive hearing loss
A steady, one-sided hearing loss caused by ossicular erosion — often confirmed on pure-tone audiometry before surgery.
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Retraction pocket on otoscopy
A pars flaccida or posterior pars tensa retraction pocket filling with keratin debris — best seen under a microscope with microsuction.
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HRCT temporal bones findings
A soft-tissue mass in Prussak’s space, scutum erosion or ossicular destruction on high-resolution CT — the anatomical map for surgery.
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Suspected residual or recurrent disease
MRI non-EPI DWI shows a bright signal where keratin has come back — used at nine to twelve months instead of, or alongside, second-look surgery.
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Vertigo or fistula symptoms
Dizziness on pressure changes or loud sound (Tullio) suggests a labyrinthine fistula — a strong indication for surgery, and a warning for the surgeon.
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Facial nerve weakness
Any facial nerve weakness in the setting of chronic ear disease is urgent — the nerve runs through the operative field and needs decompression.
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Red flag: intracranial complications
Severe headache, neck stiffness, high fever or new neurological signs with a discharging ear — meningitis, brain abscess or sinus thrombosis until proven otherwise. Same-day A&E.
Procedure options
One diagnosis, several operations.
What each option on the table actually involves — and which fits which disease pattern and hearing goal.
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Atticotomy
A limited approach to disease confined to the attic — bone is removed above the ear canal to expose and clear the cholesteatoma, often with reconstruction of the scutum.
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Canal wall up (CWU) mastoidectomy
The posterior canal wall is preserved. Better anatomy afterwards, easier hearing aid use — at the cost of a higher recurrence rate and, usually, a planned second look.
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Canal wall down (CWD) mastoidectomy
The posterior canal wall is taken down, creating an open cavity. Lower recurrence rate, but a cavity that may need lifelong microsuction and can leak with water.
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Endoscopic ear surgery
A rigid endoscope through the ear canal for disease in the attic, mesotympanum or sinus tympani — often without a mastoidectomy at all in selected cases.
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Tympanoplasty
Repair of the tympanic membrane with temporalis fascia, tragal perichondrium or cartilage — done at the same operation as the mastoid work.
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Ossiculoplasty
Reconstruction of the ossicular chain with a PORP or TORP prosthesis, cartilage or the patient’s own remodelled incus — hearing gain depends on the state of the stapes and the middle ear.
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Second-look surgery
A planned re-exploration at nine to twelve months to check for residual keratin and, if the first stage was staged, complete ossicular reconstruction.
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Mastoid obliteration
The mastoid cavity is filled with bone pâté, bioactive glass or a flap — used with CWD or after CWU to reduce cavity problems and support hearing reconstruction.
Our vetted London network
A small panel of otologists, we picked them.
Consultant otologists across central and greater London with subspecialty ear surgery training. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every otologist in our network.
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Consultant otologists with subspecialty ear and skull base training
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Facial nerve monitoring available for every mastoid case
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Both microscopic and endoscopic ear surgery offered
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Access to MRI non-EPI DWI for post-operative surveillance
Safety and recovery
What to expect afterwards — honestly.
Cholesteatoma surgery is safe in experienced hands, but it is real ear surgery. The things worth planning are the facial nerve risk, the hearing outcome and the surveillance for recurrence.
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Facial nerve injury is the surgeon’s first worry
The facial nerve runs through the operative field. Continuous nerve monitoring and careful drilling keep the risk very low — but it is never zero, and the risk is quoted honestly.
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Some hearing loss is possible
Even in expert hands there is a small risk of worsening hearing or dead ear from inner-ear trauma, especially where disease sits on the stapes or a fistula is present.
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Dizziness for a few days
Brief unsteadiness after mastoidectomy is common and settles within days. Persistent vertigo or new nystagmus is not normal and needs review.
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Altered taste from chorda tympani
The chorda tympani nerve carries taste from the front of the tongue and is often stretched or sacrificed. Metallic taste or numbness can last weeks to months.
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CSF leak — rare, but reported
A tegmen or posterior fossa dural defect can cause a cerebrospinal fluid leak. Usually repaired at the same operation, occasionally noticed later as clear ear discharge.
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Recurrence and residual disease
Recurrent cholesteatoma comes from a new retraction; residual is keratin left behind. Both are watched for with MRI DWI at nine to twelve months or a second-look operation.
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Water precautions and cavity care
After canal wall down surgery the cavity needs to be kept dry and reviewed with microsuction from time to time — plugs for swimming, no diving.
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Post-operative conductive hearing loss
A first-stage operation without ossiculoplasty leaves a hearing gap that is closed at the second stage. Bone-conduction hearing aids are an option in the meantime.
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Red flags
Facial weakness, severe headache, neck stiffness, high fever, new vertigo or sudden hearing loss after ear surgery are not normal — call the team or A&E the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever approach was used, the note the otologist sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Indication and side operated
Why the operation was done — cholesteatoma, retraction pocket, previous surgery — and which ear was operated on.
- 02 Technique
Approach and reconstruction
Whether atticotomy, canal wall up or canal wall down mastoidectomy was used, the graft material for the tympanic membrane, and any prosthesis for the ossicular chain.
- 03 Findings
Extent of disease, ossicles, fistula
Where the cholesteatoma sat, which ossicles were eroded, whether a labyrinthine or tegmen fistula was found, and the state of the facial nerve.
- 04 Impression
Recovery, hearing plan, surveillance
Read this first: pack-out timing, when to expect an audiogram, and whether MRI DWI or a second-look operation is planned — and when.
Recognised by major UK insurers
Cholesteatoma surgery is almost always covered by UK medical insurers as a medically necessary procedure. We confirm cover, procedure codes and any excess before booking.
Frequently asked
Everything we get asked about cholesteatoma surgery.
Quick answers on canal wall choice, hearing outcomes, second-look surgery and MRI DWI surveillance.
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What is a cholesteatoma?
A cholesteatoma is a slow-growing, destructive collection of keratinising squamous epithelium (skin) inside the middle ear or mastoid. It is not a cancer, but it erodes bone — the ossicles, the labyrinth and, in rare cases, the skull base — and it does not resolve without surgery.
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Why can it not be treated with antibiotics or drops alone?
Drops and antibiotics settle the infection that comes with a cholesteatoma, but they do not remove the skin sac itself. Surgery is the only definitive treatment; medical therapy is used to dry the ear before the operation.
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Canal wall up or canal wall down — which is better?
Neither is universally better. Canal wall up preserves anatomy and hearing aid use but has a higher recurrence rate and usually needs a second-look operation. Canal wall down clears disease more completely but leaves an open cavity that needs lifelong care. The decision depends on disease extent, ear anatomy and your priorities.
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How much does private cholesteatoma surgery cost in London?
Roughly £7,500–£12,000 for canal wall up mastoidectomy and tympanoplasty, £8,500–£13,500 for canal wall down, and £6,000–£10,000 for selected endoscopic cases. Imaging (HRCT and MRI DWI) and audiology are additional. We confirm a firm figure within one working day.
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Will my hearing improve after surgery?
The first aim is disease clearance and a safe, dry ear. Hearing reconstruction with ossiculoplasty is often done at the same time or at a second stage — results depend on the state of the stapes, the middle-ear space and whether the operation is a first or repeat procedure.
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What is a second-look operation, and do I still need one?
A planned re-exploration at nine to twelve months after canal wall up surgery, to check for residual keratin and complete ossicular reconstruction. In some centres, MRI non-EPI diffusion-weighted imaging has replaced routine second-look surgery — the choice is made case by case.
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What is MRI DWI, and why do you keep mentioning it?
Non-echo-planar diffusion-weighted MRI shows cholesteatoma as a bright signal, distinguishing it from scar tissue, fluid and granulation. Reliable at picking up residual or recurrent disease at 3 mm or above — the reason many otologists now offer imaging surveillance instead of routine second-look surgery.
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How long is the recovery?
Most patients are home the next day, back to office work in one to two weeks, and to full activity in four to six weeks. Water precautions continue for six weeks; flying is usually avoided for two to four weeks depending on the ear seal.
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What are the serious risks I need to know about?
Facial nerve injury, worsening or complete hearing loss on the operated side, persistent dizziness, altered taste from chorda tympani injury, cerebrospinal fluid leak, and recurrence of disease. All are quoted honestly, with numbers, before you consent.
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When should I go to A&E?
Severe headache, neck stiffness, high fever, new facial weakness, sudden hearing loss, or vertigo with a discharging ear are all reasons to seek same-day medical help — these can signal meningitis, brain abscess or sinus thrombosis.
Related tests
Looking for something else?
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Microscopic examination and microsuction
The essential first step — cleaning and inspecting the ear canal under the microscope.
Learn more -
Hearing loss assessment
A full clinical assessment of adult hearing loss and its causes.
Learn more -
Pure-tone audiometry
The formal hearing test that maps thresholds across frequencies.
Learn more -
All tests
Every test and procedure we arrange.
Learn more -
Tinnitus
Related condition guide.
Learn more -
Chronic Sinusitis
Related condition guide.
Learn more -
Private Audiology Assessment
Related diagnostic test.
Learn more
In practice, in London
Booking cholesteatoma surgery privately in London — what actually happens
For cholesteatoma surgery, the private London route is mostly about consultant fit and hospital choice rather than raw waiting time. Public provision for cholesteatoma surgery is competent but constrained by capacity. Private London clinics tend to have shorter diaries and longer appointment slots, so you get the same specialists with more time. For people who’ve been going round in circles with primary care, that first proper conversation is often what shifts things.
A private cholesteatoma surgery pathway in London usually looks like this: an initial consultation, any diagnostics booked at a nearby facility (most within Zone 1 or 2), and a written report sent to you and your GP within a few days. The consultants we work with hold NHS posts alongside their private lists, which keeps the standards consistent across both settings. For cholesteatoma surgery in particular, we bias towards consultants who do this every week rather than every month.
There are a lot of consultants in London who can technically handle cholesteatoma surgery. Fewer who do it week in, week out for the exact question you’re bringing. We spend most of our time working out which is which — and being straight when a different test or a different specialist would serve you better. Everything runs to CQC, GMC and Royal College standards; the choice is about fit, not floor.