Bilateral external auditory canal cholesteatoma: A rare otologic entity in a 49-year-old woman

Primary external auditory canal cholesteatoma (EACC) is a rare condition characterized by keratinizing squamous epithelium causing progressive bony erosion of the external auditory canal. Bilateral primary EACC is exceptionally uncommon. We report a 49-year-old woman who presented with progressive bilateral hearing loss, intermittent otorrhea, and dull otalgia. Otoscopic examination revealed keratin debris and canal wall erosion in both ears. High-resolution computed tomography demonstrated bilateral posterior canal wall erosion without middle ear involvement. She had no history of ear surgery, trauma, or systemic disease. The left ear was managed with examination under anesthesia and toileting, while the right ear required modified radical mastoidectomy with type III tympanoplasty and mastoid cavity obliteration. Histopathology confirmed cholesteatoma. This case highlights the importance of distinguishing EACC from other external canal pathologies and emphasizes early imaging and individualized management to prevent complications and ensure favorable outcomes.