First reported case of an intradural otic polyp arising from a cranial nerve with concomitant middle ear cholesteatoma.

Background: Otic (aural) polyps are benign inflammatory lesions typically arising from chronic middle ear inflammation and commonly associated with cholesteatomas. While generally confined to the external auditory canal or middle ear, their occurrence within the cranial cavity is exceptionally rare. Case Description: We present a case of a 69-year-old female who presented with a 2-week history of right House- Brackmann equivalent grade 5 facial nerve palsy and profound right sensorineural hearing loss. Magnetic resonance imaging brain demonstrated a middle ear cholesteatoma extending into the internal auditory canal, involving the facial nerve canal and otic capsule. Computed tomography temporal bone showed extensive destruction and expansion of the right mastoid air cells and erosion of the ossicles and the lateral semicircular canal. Conclusion: This case describes the first documented case of an intradural otic polyp, associated with a middle ear cholesteatoma, located within the cerebellopontine cistern and originating from a cranial nerve. This case expands the known anatomical distribution of otic polyps and emphasizes the importance of including them in the differential diagnosis of cerebellopontine angle lesions, particularly in the context of adjacent cholesteatoma and patients with a relatively acute presentation. It also underscores the value of intraoperative neuromonitoring in guiding safe resection of lesions involving cranial nerves.