A 27-year-old female was complaining of headache and gait disturbance. Although the tympanic membrane had a normal appearance, a CT scan revealed a soft tissue density in the tympanic cavity and mastoid air cells in the left side. Adjacent to this lesion, there was a ring-form shadow in the left cerebellar hemisphere enhanced with contrast medium.
Under the diagnosis of congenital cholesteatoma with a cerebellar abscess, antibiotics were administered intensively. After relief of cerebellar abscess, left tympanoplasty (two-staged operation) was performed. The middle ear structures were markedly destroyed by cholesteatoma. The ossicular chain was reconstructed by using an autologous cartilage graft from the auricle (columella type IV procedure). The postoperative hearing was improved by 20 dB. There has been no evidence of cholesteatoma recurrence.
