ObjectiveThis study aimed to determine whether chronic otitis media (COM) with cholesteatoma over time is associated with a decrease in neurosensory function.Study DesignThis study was a review of a database of all patients with cholesteatoma treated surgically.SettingThe study was conducted at a tertiary care medical center and specialty hospital.PatientsThere were children and adults with unilateral COM with acquired, nontraumatic cholesteatoma in this study.InterventionsAll patients received preoperative pure-tone bone conduction and speech audiometry.Main Outcome MeasuresInteraural difference between the cholesteatomatous and normal ears comparing bone conduction pure-tone average (BC-PTA), pure-tone threshold at 4,000 Hz (BC4000), and/or speech discrimination score (SDS) as measured by a repeated measures analysis of covariance, with age as a covariate was examined.ResultsA significant difference between ears for SDS and BC4000 that does not vary with age was identified. A significant interaural difference for the BC-PTA that varies with patient age was identified.ConclusionsChronic otitis media with cholesteatoma is associated with a decrease in neurosensory function, even in the absence of frank inner ear invasion.