Cholesteatoma With Cochlear Fistula and Carotid Dehiscence

Abstract

Cholesteatomas are non-neoplastic, invasive lesions created by the accumulation of keratinized squamous epithelium in the temporal bone. If left untreated, its expansion may cause local destruction of the surrounding structures, eventually leading to inner ear fistula, dehiscence of tegmen and possible intracranial pathology, and facial nerve paralysis. Surgical resection is the mainstay of curative treatment. We hereby present a case of a giant cholesteatoma in a 62-year-old patient who presented with a right-sided hemifacial spasm with later paralysis who was treated with botulinum toxin injection by a neurologist. CT scan imaging showed a very large cholesteatoma with involvement of the carotid canal, cochlea, and geniculate ganglion. The patient underwent transmastoid and subarcuate approach for resection which led to marked improvement of her symptoms.

Symptom: Left-Sided Ear Drainage

“…Cholesteatomas are, at their most basic definition, the occurrence of squamous epithelium (skin) in areas of the temporal bone where it does not belong. That can be in the middle ear, the mastoid, the petrous apex, or other epidural or intracranial locations 1–4 . Rarely, cholesteatomas can occur in the bony ear canal.…”