Right-sided auditory hallucinations after tympanomastoidectomy: A rare case report and management insights

We report a 58-year-old female with recurrent right-sided cholesteatoma who underwent tympanomastoidectomy. Imaging revealed extensive cholesteatoma with ossicular erosion. Postoperatively, she developed persistent unilateral linguistic auditory hallucinations in her previously deaf right ear. She described hearing accusatory and distressing voices. In contrast to typical non-linguistic postoperative auditory disturbances like tinnitus or musical hallucinosis, these hallucinations were highly structured. This progressed to delusions, including one of a tube implanted in her ear during surgery. Notably, she lacked internal emotional attribution typical of psychiatric illness; her hallucinations were closely linked to her surgery, suggesting a peripheral or neuro-otological etiology secondary to surgical stress on a chronically sensory-deprived auditory system. This case illustrates unilateral auditory hallucinations following tympanomastoidectomy, likely due to peripheral auditory disruption and microangiopathic brain changes. Symptoms improved with antipsychotics and anxiolytics. Early recognition of non-psychiatric causes and interdisciplinary management are crucial to prevent misdiagnosis and ensure appropriate treatment.