Medical Specialties

At the Center for Neurosciences, we work together across specialties to provide the best, most comprehensive approach to treatment.


Cholesteatoma, a benign (non-cancerous) type of tumor, consists of skin cells that abnormally accumulate in pockets within the middle ear/mastoid. As cholesteatomas grow, they erode hearing bones and typically conductive hearing loss. Another common symptom is persistent ear drainage (often mucous or pus) that has a foul odor. Cholesteatomas grow until they are surgically removed. There are no medications effective against cholesteatoma tumors. Advanced symptoms of late-stage disease include dizziness, facial paralysis, deafness, meningitis, or even brain abscess formation. Death is rare but possible.

Cholesteatomas can be congenital (present at birth), but are most often acquired. Congenital cholesteatomas occur when small pieces of skin are trapped in the middle ear space at birth. Acquired cholesteatomas result from tympanic membrane perforations or Eustachian tube dysfunction. In most situations, surgery is recommended due to the potential complications associated with uncontrolled infection and progressive skull base erosion. For those with serious medical comorbidities that preclude administration of anesthesia, periodic in-office cleanings under the microscope may be an alternative.

The main goals of surgery are to treat infection and create a dry, safe ear. While hearing typically improves, it may be unchanged or even worsened by maximal efforts to eradicate infection/trapped skin. In most cases, hearing loss can be rehabilitated using a variety of surgical and non-surgical technologies.

Why Choose Us

  • Dr. Abraham Jacob, Medical Director for Ear & Hearing (E&H) at the Center for Neurosciences (CNS), is fellowship trained in Otology, Neurotology, and Cranial Base Surgery. He is the first and most experienced Neurotologist in Southern Arizona.
  • Dr. Jacob was a founding member of the University of Arizona (UA) Department of Otolaryngology prior to his departure and transition to CNS. At UA, he was Vice Chair of ENT surgery and held the rank of full Professor with Tenure.
  • Dr. Jacob transitioned his practice to the Center for Neurosciences in early 2017 as he felt that the new environment helped him to optimize delivery of personalized ear and lateral skull base care for his patients.
  • Dr. Abraham Jacob offers state-of-the-art medical & surgical care for all ear and lateral skull base disorders. Unmatched in training and with substantial clinical experience, Dr. Jacob has helped thousands of patients medically manage, surgically treat, and appropriately rehabilitate (hearing aids and implantable hearing technologies) ear disease. Experience matters for obtaining best-outcomes in managing cholesteatoma.