A case of congenital cholesteatoma in adult patient with intermittent episodes of facial palsy.

INTRODUCTION AND IMPORTANCE

Congenital cholesteatoma is a rare entity that arises from epithelial cell rests in the middle ear, parts of temporal bone or even intracranially. However, it can go unrecognized for several years making the consideration of such diagnosis a bit tricky among otologists.

CASE PRESENTATION

We are reporting a case of a young female adult who presented with unilateral hearing loss for one year and intermittent episodes of facial twitching in addition to periods of recurrent unilateral facial palsy that happened about three times in the past two years.

CLINICAL DISCUSSION

Otoscopic examination revealed a slight whitish mass behind the superior half of an intact tympanic membrane. High-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) proposed a differential diagnosis of congenital cholesteatoma and facial schwannoma. Canal wall up (CWU) mastoidectomy with exploration of anterior epitympanum and partial facial nerve decompression was made with complete removal of cholesteatoma mass and ossicular reconstruction.

CONCLUSION

A recurrent or non-resolving facial asymmetry in an otherwise healthy adult should raise the suspicion among otolaryngologists to investigate the possibility of congenital cholesteatoma.