Hypertrophic pachymeningitis of the internal auditory canal and cerebellopontine angle from a large recurrent attic cholesteatoma

Am J Otolaryngol. 2024 Jul-Aug;45(4):104263. doi: 10.1016/j.amjoto.2024.104263. Epub 2024 Mar 18.

Abstract

Objectives: To describe a rare complication of cholesteatoma.

Methods: Case report with literature review.

Results: We report a case of a 37-year-old male who presented for evaluation of otorrhea, headache, and progressive left sensorineural hearing loss. Clinical and radiologic evaluation demonstrated a large recurrent attic cholesteatoma with erosion into the lateral and superior semicircular canals, and diffuse enhancement of the internal auditory canal and cerebellopontine angle suggestive of hypertrophic pachymeningitis secondary to cholesteatoma. After treatment with a course of antibiotics and canal wall down mastoidectomy surgery for cholesteatoma exteriorization, he experienced improvement of his symptoms and resolution of hypertrophic pachymeningitis.

Conclusion: Hypertrophic pachymeningitis is a rarely described complication of cholesteatoma. In the context of cholesteatoma, treatment with antibiotics and surgical removal or exteriorization of cholesteatoma are effective treatments for HP.

Keywords: Cholesteatoma; Hypertrophic pachymeningitis; Internal auditory canal.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Cerebellopontine Angle* / diagnostic imaging
  • Cerebellopontine Angle* / surgery
  • Cholesteatoma, Middle Ear* / complications
  • Cholesteatoma, Middle Ear* / surgery
  • Ear, Inner / diagnostic imaging
  • Ear, Inner / surgery
  • Humans
  • Hypertrophy*
  • Magnetic Resonance Imaging
  • Male
  • Mastoidectomy / methods
  • Meningitis* / complications
  • Meningitis* / etiology
  • Recurrence
  • Tomography, X-Ray Computed