Aural cholesteatoma with upper neck extension

We report the case of a 32-year-old Chinese woman who presented with a large cholesteatoma in her right upper neck after a history of ipsilateral chronic otitis media since childhood. Intraoperatively, a cholesteatoma was found in the mastoid cavity, and the mass in her neck was attached to the mastoid cortex by a stalk. Direct erosion of the mastoid tip may have led the cholesteatoma epidermis to enter the deep surface of the sternocleidomastoid muscle, allowing debris accumulation to form the mass, similar to the propagation of pus in a Bezold's abscess. Neck cholesteatoma secondary to aural cholesteatoma is fairly rare. Only five reports were identified before 1989 followed by no reports in the past 20 years. The case we reported is a reminder to otolaryngologists that this unusual condition still occurs.