Summary

• Accumulation of squamous epithelium and keratin debris that usually involves the middle ear and mastoid.
• Although benign, it may enlarge and invade adjacent bone.
• Often presents with a malodorous ear discharge with associated hearing loss.
• Diagnosis is clinical based on history and otoscopic findings. CT scan provides lesion definition and extent.
• Treatment is surgical removal. Adjunctive topical antimicrobial treatment may help reduce acute symptoms preoperatively.
• Complications include recurrence, meningitis, facial palsy, and a labyrinthine fistula.