DOI: https://doi.org/10.36347/sjmcr.2026.v14i03.013

Pages: 375-381

Middle ear cholesteatoma is a destructive, keratinizing lesion capable of eroding ossicles, mastoid air cells, and in severe cases, the fallopian canal leading to facial nerve palsy. Although facial nerve paralysis secondary to cholesteatoma is rare, its presence demands urgent surgical management to prevent permanent neurological damage. We present the case of a 45-year-old male named Abdur Rahman, who suffered for decades with progressive facial weakness, hearing loss, chronic otorrhea, and eventually facial nerve dysfunction caused by an extensive cholesteatoma involving the mastoid cavity and middle ear. He underwent tympanomastoid surgery followed by decompression of the facial nerve. The operation was complex due to adhesions, severe canal erosion, and anatomical distortion. Post-operative recovery demonstrated significant functional improvement. This case emphasizes the importance of early diagnosis, high clinical suspicion, advanced imaging, and timely surgical intervention in preventing irreversible facial paralysis and life-threatening intracranial complications.