This variant of lipoma contains mature adipocytes, blood vessels, and dense collagenous tissue. The physical examination can be misleading, and the diagnosis requires histopathological examination. The patient was treated with complete surgical excision, tympanoplasty, canalplasty, and skin grafting to the external auditory canal. His pure-tone average improved from 37 to 11 dB, and his air-bone gap was closed completely. The lipoma has not recurred in the 6-month period following surgery.