TITLE:
Middle Ear Cholesteatoma Complicated by Posterior Fossa Empyema: A Case Report and Review of Practical Management Strategies
AUTHORS:
Ichraq Horrane, Razika Bencheikh, Tarek Dahan, Moad El Mekkaoui, Zakaria El Hafi, Zakaria Arkoubi, Mohammed Anas Benbouzid, Leila Essakalli
KEYWORDS:
Cholesteatoma, Chronic Otitis Media, Posterior Fossa Empyema, Mastoidectomy, Otogenic Intracranial Complications
JOURNAL NAME:
Voice of the Publisher,
Vol.12 No.3,
September
28,
2026
ABSTRACT: Cholesteatomatous chronic otitis media (COM) remains a significant health problem in developing regions, where delayed diagnosis predisposes patients to extensive bone destruction and intracranial complications. We report the case of a 38-year-old male with an approximately 9-year history of untreated left otorrhea (onset ~2009), progressive hearing loss, and previous cerebellar abscess and subdural empyema. High-resolution CT revealed bilateral cholesteatoma with extensive erosion of the mastoid, posterior fossa plate, and sinus plate, associated with a stable 11-mm posterior fossa empyema. The patient underwent canal-wall-down mastoidectomy with complete removal of cholesteatoma and reconstruction of the posterior fossa defect. No immediate neurosurgical intervention was indicated. This case illustrates the destructive potential of neglected cholesteatoma and highlights essential principles for safe surgical management of advanced disease.