Learning Objectives: External Ear Canal Cholesteatoma, even when very extensive, can be successfully treated with excellent hearing outcomes.

Introduction: The aetiology of external ear canal cholesteatoma (EECC) may be traumatic, iatrogenic or spontaneous. It is a rare entity with an estimated incidence of around 1 in 1000 patients requiring otologic surgery. Remarkably, we present two cases operated on same the day by the senior author!

Methods: 2 cases are presented including pre-operative imaging. An 80 year old female who presented with a 3 month history of left-side hearing loss. Microsuction for “hard wax” was performed several times before CT scan was requested. A 61 year old female with a short history of left-sided hearing loss and pain. Hard “wax” was removed by microsuction several times. The tympanic membrane was seen to be normal and she was discharged before representing with the same symptoms. Eventually a CT scan was requested. Both patients underwent modified radical mastoidectomy. In the first case the cholesteatoma sac was seen to be originating from the anteroinferior wall of the ear canal and extending into the mastoid. The tympanic membrane was intact and middle ear uninvolved. The second patient was found to have cholesteatoma arising from the postero-inferior wall of the ear canal with extension into the mastoid and petrous bones.Middle fossa dura was widely exposed by the disease. The lateral SCC was dehiscent. The tympanic membrane was normal and the middle ear uninvolved.

Results: Post-operatively, both patients recovered well with no complications and audiometry showed no conductive hearing loss and no worsening of bone conduction. Both patients remain under long-term follow-up.

Conclusion: EECC can present with minimal clinical findings and hearing loss but can be very extensive which could lead to serious complications if left undetected for a long time. CT scanning is extremely helpful in assessing the extent of the disease and for assisting in pre-operative planning.