Although much has been written about the central nervous system infectious complications of otitis media, little has been written about intracranial extension of cholesteatoma in chronic otitis media. The records of 13 patients from the House Ear Clinic with chronic otitis media and cholesteatoma extending into the middle fossa and/or the posterior fossa are reviewed. Preoperatively, symptoms included hearing loss (100%), dizziness (61%), facial weakness (46%), and headache (31%). All 13 patients had previously undergone at least one mastoidectomy procedure for removal of cholesteatoma. The neurotologic approaches used included the middle fossa, translabyrinthine, and transcochlear operations. Eradication of cholesteatoma was accomplished with one neurotologic procedure, in 11 of 13 patients with two neurotologic procedures in one patient, and without surgery in one patient. Audiologic findings and facial nerve results are discussed.