Congenital mastoid cholesteatoma in an 87-year-old lady treated by watchful waiting

ongenital cholesteatoma (CC) of the ear is a benign, slow-growing epidermoid cyst consisting of keratinized squamous epithelium, which may expand and destroy surrounding tissues. For a clinical case to be considered as a CC, there should be no previous history of tympanic disease, such as tympanic membrane retractions or ear discharge, and no previous ear surgery. This occurs most commonly in the middle ear, and because it typically causes ossicular erosion with hearing impairment, detection tends to occur relatively early.1 Congenital mastoidal cholesteatomas (CMCs; ie, CC originating from the mastoid process) are rarer, and because they cause few early symptoms, they tend to go undetected for many years. Thus, they are often detected in adulthood.2 The diagnosis is confirmed with radiology, which is conclusive when applying current technologies. This includes computed tomography (CT) and magnetic resonance imaging (MRI) with a cholesteatoma protocol. High-resolution CT displays a nonspecific soft-tissue mass without connection to the tympanic membrane or to the external ear canal. On MRI, the cholesteatoma appears hypointense on T1-weighted images and hyperintense on T2-weighted images.3 The current standard of treatment is surgical eradication