• Pei-Shao Liao, Wei-Che Lan, Ching-Yuan Wang, Chia-Der Lin, and Yu Aoh.
• Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.
• Medicine (Baltimore). 2024 Mar 22; 103 (12): e37511e37511.

IntroductionCholesteatoma is a rare disease characterized by the accumulation of keratinized squamous epithelial cells in the middle ear or mastoid cavity. Vertigo and facial palsy, which are rare complications, may indicate erosion into the semicircular canals or the fallopian canal.Patient ConcernsA 40-year-old woman presented to our clinic with progressive right-sided hearing loss over 5 years (primary concern). Approximately 10 years ago, the patient had developed acute right-sided facial weakness with no additional symptoms. A neurologist at another hospital had diagnosed her condition as Bell's palsy and treated it accordingly.DiagnosisAdult-onset congenital cholesteatoma in the hypotympanum.InterventionCombined endoscopic and microscopic removal of the cholesteatoma.OutcomesPhysical examination revealed slight improvement in right-sided peripheral facial palsy.LessonRoutine eardrum examination is recommended for patients presenting with isolated peripheral facial palsy. If necessary, a patient should be referred to an otologist for further evaluation and treatment.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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