Recurrent Cholesteatoma Presenting as Severe Otalgia and Dizziness.

Residual cholesteatoma is a known potential pitfall of surgical resection. While most patients with suspected residual disease undergo second-look surgery or magnetic resonance imaging (MRI) for surveillance, the very long-term consequences of subclinical residual cholesteatoma are rarely described. We present the case of a 64-year-old male who presented with severe otalgia and dizziness 45 years after his last otologic surgery. Subsequent examination and imaging revealed a giant cholesteatoma with significant intracranial extension, developed over nearly half a century.