Aural cholesteatoma presenting as a large neck mass.

Aural cholesteatoma occurring as a mass in the neck, reported only twice before, follows the same spreading pattern as pus in Bezold's mastoiditis. Our patient became aware of the mass only when his previously exteriorized cavity became infected. We believe that the deep dependent mastoid tip and infection enhanced the spread of cholesteatoma into the neck, but that penetration of the mastoid cortex and initial silent accumulation of debris began years before. Recent evidence suggests that such erosion of bone may result from enzymatic degradation even in a so-called dry ear. This unusual case of massive swelling in the neck as a result of aural cholesteatoma exemplifies the need for careful preoperative assessment and operative management of any patient with a neck mass.