Simultaneous occurrence ofcholesteatoma and vestibularschwannoma - surgicalchallenges and analysis ofpotential solutions.

<b>Introduction:</b> Vestibular schwannoma (VS) is the most common cerebellopontinetumor, causing sensorineural hearing loss, tinnitus, and vertigo. Chronic otitis mediawith cholesteatoma presents with recurrent ear discharge and hearing loss, typicallyrequiring surgical intervention. Although the coexistence of VS and cholesteatoma israre, it creates complex diagnostic and therapeutic challenges that necessitate individualized management approaches.<b>Aim:</b> : Considering the rare coexistence of VS and cholesteatoma, we aimed to analyze diagnostic patterns and therapeutic outcomes in our patient cohort.<b>Materials and methods:</b> We reviewed four patients with simultaneous VS and cholesteatoma. One patient presented with cholesteatoma in one ear and VS in the contralateral ear, and underwent middle ear cholesteatoma removal via an endaural approach, followed by translabyrinthine VS resection. The other three patients had ipsilateral lesions; two were managed with a transotic approach for the simultaneous removal of both lesions, while one underwent closed-cavity cholesteatoma surgery, with a cerebellopontine angle tumor subsequently detected and treated with gamma knife radiosurgery.<b>Results:</b> During a follow-up period of two to four years, no residual or recurrent cholesteatoma or tumor was observed in all patients except the one treated with gammaknife, who remained stable post-treatment.<b>Conclusions:</b> A tailored treatment strategy based on tumor stage, hearing status, patient age, and cholesteatoma characteristics resulted in favorable functional and anatomical outcomes. The coexistence of cholesteatoma and VS should be consideredin the differential diagnosis of hearing loss. Our findings underscore the importanceof a multidisciplinary approach in managing these rare concurrent conditions, ultimately optimizing hearing preservation and overall quality of life.