Learning Objectives: A rare case of Extensive cholesteatoma with Bezold's abscess.

Introduction: A case of 19 year female patient with complains of continuous foul smelling discharge and swelling behind ear in mastoid region extending to upper neck region came to our OPD, On examination it was diagnosed as attico antral type of COM with Bezold's abscess diagnosis confirmed by CT imaging.

Materials and Methods: All the necessary investigations viz. Routine Blood investigations, serological profile, imaging studies i.e HRCT Face including Temporal bone and neck, Pure tone Audiometry was done which showed severe conductive hearing loss on the affected side. Patient was planned for I and D of abscess further planned for Radical mastoidectomy under GA.

Result: Following I & D we saw large amounts pus draining from abscess and erosion of cortical bone with huge extensive cholesteatoma debris, hence planned for mastoidectomy extending the incision further planned for radical mastoidectomy, we saw huge extensive cholesteatoma filled in mastoid cavity with multiple fistulae was noted, steps of radical mastoidectomy followed, adequate post op care was taken.

Conclusion: Cholesteatoma has been known to be associated with multiple complications either extracranially or intracranially. Among the extracranial complications, mastoiditis and mastoid abscess are the most common. Bezold's abscess formation with cholesteatoma is a rare occurrence but when present can lead to sinister sequalae if not properly managed. The treatment of cholesteatoma is mainly by surgical exploration namely mastoidectomy. The aim of treatment is to eradicate the diseased mastoid and to prevent subsequent complications. Beside surgical intervention, the patient will also require intensive systemic and topical antibiotic therapy. With proper treatment patient will be rescued from experiencing further life-threatening complications.