# Danger of Delay: A Case Report of a Hidden, Extensive, Congenital External Auditory Canal Cholesteatoma in a Pediatric Patient

## TL;DR

A rare case of a hidden ear condition in a child led to serious complications due to delayed diagnosis and treatment.

## Contribution

Highlights the risk of delaying CT scans in congenital aural stenosis patients to prevent severe complications.

## Key findings

- A pediatric patient with congenital aural stenosis developed a brain abscess due to undetected cholesteatoma.
- Delayed CT scan diagnosis led to severe complications, emphasizing the need for timely imaging in CAS patients.
- Computed tomography is crucial for diagnosing cholesteatoma in CAS despite lack of clinical symptoms.

## Abstract

Congenital aural stenosis (CAS) is a rare congenital ear abnormality affecting the external and middle ear. It has a higher risk of developing external auditory canal cholesteatoma (EACC) compared to congenital aural atresia. CAS is defined when the external auditory canal has a diameter of 4 mm or less. This size makes it difficult to examine and confirm the diagnosis.Thus, a computed tomography (CT) scan is necessary to be performed despite the absence of clinical symptoms indicative of cholesteatoma in CAS patients. The findings from the CT scan can guide further management. This is a case of extensive EACC complicated by a brain abscess in a young boy with CAS. Due to the patient factors, a timely CT scan to detect EACC was impeded, which resulted in more serious complications. Our case report aims to underscore the peril of postponing appropriate management of this disease.