Pediatric Cholesteatoma Presenting as Persistent Otorrhea: A Case of Delayed Diagnosis Across Multiple ENT Specialists

ABSTRACT

Pediatric cholesteatoma is an aggressive but uncommon middle ear condition characterized by keratinizing squamous epithelium that can progressively erode adjacent structures. It is associated with faster bone destruction and higher recurrence rates in children than adults, and its symptoms often resemble chronic otitis media, which may delay diagnosis and treatment. A 4‐year‐old boy presented with persistent foul‐smelling otorrhea from the left ear and conductive hearing loss. Otoscopic examination revealed a retracted tympanic membrane with a whitish epitympanic mass. High‐resolution CT demonstrated soft‐tissue density in the middle ear with scutum erosion. The patient underwent canal wall‐up mastoidectomy with tympanoplasty, and intraoperative findings confirmed cholesteatoma with partial ossicular erosion. This case reflects the insidious clinical presentation of cholesteatoma and emphasizes that chronic otorrhea and unilateral hearing loss may indicate destructive middle ear disease rather than benign infection. Imaging plays a critical role in diagnosis and surgical planning, particularly in detecting bony erosion and disease extent. Maintaining a high index of suspicion for cholesteatoma in children with persistent discharge or unexplained conductive hearing loss is essential. Early diagnosis and timely surgical intervention are crucial to prevent irreversible complications and reduce recurrence risk.