Hidden Peril in the Ear: A Case of External Auditory Canal Cholesteatoma in a Teenager.

External auditory canal cholesteatoma (EACC) is a rare otologic condition characterized by the accumulation of keratinized material in the external auditory canal (EAC), leading to progressive bony erosion. While typically associated with middle ear disease, isolated EACC in young patients is uncommon and often misdiagnosed. We report the case of a 17-year-old male who presented with left-sided otalgia, purulent otorrhea, and progressive hearing loss over 3 months. Otoscopic examination revealed a firm, yellowish mass occluding the left EAC. High-resolution computed tomography demonstrated a soft-tissue lesion confined to the EAC, with associated bony remodeling and erosion but no middle ear involvement. The mass was excised under local anesthesia, and histopathological examination confirmed the diagnosis of EACC. The patient experienced significant symptomatic relief postoperatively, with no recurrence during follow-up. EACC should be considered in the differential diagnosis of persistent otalgia and otorrhea, particularly when imaging reveals bony erosion of the EAC. Early recognition and surgical intervention are crucial in preventing complications and ensuring optimal patient outcomes.