Case 295

Spontaneous Ear Drainage After Hearing a “Pop;” No History of Surgery

This radiologic case presents a patient who experienced spontaneous ear drainage after hearing a “pop,” with no history of ear surgery. CT imaging—both axial and coronal views—reveals findings characteristic of Auto-Atticotomy, a condition caused by the natural rupture of a cholesteatoma.

Key Imaging Observations:

• Axial CT shows:
  • Yellow arrow: Smooth remodeling of the superolateral attic wall
  • Red arrow: Evidence of ossicular erosion
• Coronal CT shows:
  • White arrow: Loss of the inferolateral attic wall and blunting of the scutum

This condition mimics the surgical appearance of an atticotomy but is the result of spontaneous disease progression, particularly in chronic cholesteatoma cases. The case highlights how an auto-atticotomy can manifest without a history of otologic surgery.

Case courtesy of Adam Robinson, MD
UC San Diego Health