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A case of aural cholesteatoma extending into the middle cranial fossa is presented. The cholesteatoma appears to have recurred in an ear in which a radical mastoidectomy had been performed more than 40 years earlier. The patient complained only of a vague sensation of heat in the head and did not manifest distinct neurologic signs or symptoms. The cholesteatoma was removed through an extended endaural approach. Extension of aural cholesteatoma beyond the confines of the temporal bone appears to be quite unusual.
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