Recurrent Cholesteatoma with Skull Base Erosion: A Case Report

Cholesteatomas are non-malignant, expandable diseases that, if left untreated, can destroy the middle ear, temporal bone, and other structures. Their recurrence can cause disastrous effects, for example, skull base destruction, acute mastoiditis, and brain abscess, etc. Therefore, they need early diagnosis, and it might necessitate surgical intervention according to the complications. We present the case of a 30-year-old male patient who came to the emergency department with a picture of acute right-sided mastoiditis. The patient complained of a one-day history of right ear pain, ear swelling, fever, and purulent-bloody right-sided ear discharge. On examination, there was a postauricular swelling with redness and a whitish, thick, offensive secretion coming out of the stenosed external auditory canal (EAC) as well as a white mass in the stenosed EAC. The patient had ear surgery 14 years ago, with recurrence of the cholesteatomas, acute mastoiditis, and skull base erosion. The pure tone audiogram showed a big right-sided conductive hearing loss of 35 dB air-bone gap. Mastoid and temporal bone destruction, skull base defects, and jugular vein encasement were noted on CT, MRI, and brain angiogram of the patient. The patient underwent a revision tympanomastoidectomy with skull base reconstruction. This case report underscores the significance of early diagnosis, adequate imaging, and appropriate management of the disease with possible complications, including acute mastoiditis and skull base infiltration, which will help prevent the development of dangerous consequences, such as cerebrospinal fluid (CSF) leaks and intracranial infections.