2025 Poster Presentations
P131: PRIMARY MASTOID CONGENITAL CHOLESTEATOMA WITH SKULL BASE INVOLVEMENT: A CASE REPORT
Diego Gamoneda, BS1; Rohan A Patel, MD2; Juan Carlos Yanez-Siller, MD, MPH2; Arnaldo L Rivera, MD2; 1University of Missouri School of Medicine; 2University of Missouri Department of Otolaryngology- Head and Neck Surgery
Objective: Present a case of an incidental finding of congenital cholesteatoma (CC) with a true mastoid origin in a 61-year-old female patient who presented to clinic with muffled hearing a previous history of chronic otitis media and a left sided tympanic membrane perforation and skull base erosion.
Setting: Tertiary academic center Patient: 61-year-old female who was referred to our clinic for left sided “muffled hearing”. She had a prior history of chronic otitis media and a left sided tympanic membrane perforation. CT of the Temporal/Petrous bone showed incidental finding of a soft tissue mass with a defect through the right mastoid and erosion into the posterior fossa and concerning cholesteatoma.
Intervention: Right mastoidectomy and temporoparietal fascia skull base reconstruction.
Conclusion: Congenital cholesteatomas originating in the mastoid is an atypical presentation in adults. Despite its rarity, a high index of suspicion should be maintained in patients who present with incidental soft-tissue masses on CT imaging. The asymptomatic nature of primary mastoid CC along with its generally late presentation are some of the challenges associated with its diagnosis and management.
Figure 1: CT Temporal bone, right side in axial view reveals a soft-tissue mass within the right mastoid demonstrating skull base erosion into the posterior fossa.
Figure 2: Intraoperative finding of intramastoid cholesteatoma with associated skull base defect