A 53 years old man with an incidental finding of a cholesteatoma of left ear! He was complaining of right sided hearing loss with a history of previous tympanoplasty and during otoscopy we detected a cholesteatoma pearl and superoposterior perforation of the left tympanic membrane (blue arrow).
The most interesting part is while the diagnosis of cholesteatoma was almost definetly known according to the otoscopy view and temporal bone CT scan showing middle ear soft tissue opacity with bony boundaries erosions (red arrow), the PTA and tympanometry showed normal values! Even the patient himself said my left ear hearing is better than right side! He was right! This is called mass effect!
This point indicates the importance of patient orientation to her hearing status after mastoidectomy and tympanoplasty in the setting of cholesteatoma.
