Dual Cholesteatoma in a Non-operated Ear: A Rare Presentation

Objective: We report an interesting case where two cholesteatomas were found simultaneously in a non-operated ear. The presentation, management and implications for other patients with cholesteatoma are discussed.

Case Report: A 49-year-old male with a unilateral mixed hearing loss was found to have two cholesteatomas. Only one was suspected clinically, in the anterior attic, the other a large congenital cholesteatoma in the mastoid tip as an incidental finding on non echo-planar diffusion weighted image (Non-EPI DWI) MRI scan. The radiological findings were confirmed at surgery (combined approach tympanoplasty).

Conclusion: Congenital cholesteatoma in the mastoid process is extremely rare and multiple cholesteatomas occurring simultaneously in a non-operated ear is also rare. Non-EPI DWI MRI is increasingly used as a non-invasive technique for detecting recurrent or residual cholesteatomas post-operatively. This case supports extending the role of non-EPI DWI MRI scanning pre-operatively in primary disease to exclude additional cholesteatomas and to assess the suitability of permeatal endoscopic surgery.