Cholesteatoma-induced cerebellopontine abscess; a misdiagnosed case of chronic otitis media with temporal bone erosion: A case report and literature review.

INTRODUCTION

Cholesteatoma is a destructive lesion of keratinizing squamous epithelium in the temporal bone. Its indolent progression often delays diagnosis, leading to osteolytic erosion and temporal bone defects.

CASE PRESENTATION: A 20-year-old Syrian male presented with progressive left-sided postauricular swelling, headache, fatigue, and hearing loss, which had recurred intermittently over the past two years. Each episode was treated symptomatically with antibiotics by local providers without further investigation. On admission, he was febrile (38 °C), and otoscopy revealed an intact tympanic membrane with dense retrotympanic material. Imaging studies showed erosion of the posterior external auditory canal wall and middle ear roof, with a 2.8 cm2 cerebellopontine angle abscess connected via a fistula to the middle ear. Audiometry confirmed moderate to severe mixed hearing loss. The patient was treated conservatively with intravenous antibiotics, resulting in clinical and radiological improvement.

CLINICAL DISCUSSION: Neurosurgery managed the abscess with IV antibiotics (metronidazole, chloramphenicol). Otolaryngology recommended bony reconstruction, but the patient declined due to cost, lack of local resources, and surgical apprehension.

CONCLUSION

Cholesteatoma must be considered in recurrent antibiotic-resistant mastoiditis with hearing loss or bony erosion. Early CT and MRI prevent irreversible damage; delayed intervention risks intracranial complications.