Extensive Temporal Bone Necrosis in Petrous Bone Cholesteatoma Complicated by Actinomycosis: A Case Report

BACKGROUND Temporal bone necrosis is a rare condition, most commonly caused by radiation therapy, bisphosphonate treatment, and osteomyelitis. Cholesteatoma can contribute to temporal bone necrosis, particularly in the presence of secondary ear infections. We report a case of extensive temporal bone necrosis with intracranial involvement in a patient with mastoid and petrous apex cholesteatoma, further complicated by actinomycosis. CASE REPORT A 47-year-old woman presented with persistent otorrhea and right-sided conductive hearing loss. Imaging demonstrated diffuse necrotic tissue extending from the retroauricular soft tissues to the middle ear and the petrous apex of the temporal bone, with erosion of the tegmen tympani. An extended petrosectomy was performed with particular attention to preserving the facial nerve. Histopathologic examination revealed the coexistence of cholesteatoma, necrotic bone sequestra, and colonies of Actinomyces. Postoperatively, the patient completed a course of intravenous antibiotics and adjuvant hyperbaric oxygen therapy. At 1-year follow-up, no evidence of recurrence was observed on radiological and clinical evaluation. CONCLUSIONS This case underscores an unusual presentation of temporal bone necrosis, occurring in the absence of conventional predisposing factors. The concomitant presence of cholesteatoma and Actinomyces infection highlights the importance of considering atypical etiologies in progressive otologic disease. Early diagnosis, comprehensive surgical debridement, and multidisciplinary management were essential to achieving favorable clinical and radiological outcomes.