Management of Cholesteatoma Extension Beyond Middle Ear/Mastoid

Petrous bone or medially-invasive cholesteatoma is a rare pathologic process occurring in a difficult-to-access area of the lateral skull base with many surrounding vital structures. For this reason, patients are more likely to present with hearing loss and facial paresis. The workup of these patients requires comprehensive audiologic evaluation and imaging using high resolution CT and/or MRI with DWI sequences. The Sanna classification can be used to facilitate staging, determine the functional implications prior to and following surgery, and anticipate the most effective postoperative surveillance algorithm. More advanced neurotologic approaches should be considered due to the complex anatomy, its substantial variations in the temporal bone, as well as the advanced functional implications of the disease and its management.