Aim Bezold abscess is a extracranial complication of mastoiditis and is rarely encountered in the era of antimicrobial therapy. This case highlights recognition made difficult due to its rarity, and variability of patient presentation. Case Report A 59-year-old woman presented to the Emergency Department with a progressively enlarging left postauricular swelling, becoming painful in the last 48 hours without ear symptoms. Medical history included diabetes mellitus and a frontoparietal meningioma resected via a left postauricular approach in 2015. She was assessed by ENT in 2019 for a conservatively managed EAC choleseteatoma. Clinical examination suggested a cutaneous abscess. The EAC was reported to be normal, without obvious middle ear pathology. There were no signs of sepsis. Blood tests showed normal inflammatory markers. The abscess was drained under local anaesthetic. The patient was admitted for intravenous antibiotics. The wound did not improve despite treatment. Microbial cultures were inconclusive. Computed tomography showed extensive erosion in the left mastoid, and areas in the posterior EAC. The patient proceeded to a cortical mastoidectomy, where a canal cholesteatoma extended to a cortical defect, forming a subperiosteal abscess cavity extending into the sternocleidomastoid. The patient was discharged with oral antibiotics and is scheduled for definitive surgery. Conclusion Bezold abscess secondary to canal cholesteatoma is a rare entity. Late recognition can lead to severe complications, including sinus thrombosis and deep neck space infection. Diagnosis may be challenging due to varied symptoms and clinician unfamiliarity with a rare complication. References 1. Alkhaldi A, Alwabili M, Albilasi T, Almuhanna K. Bezold’s abscess: A case report and review of cases over 20 years. Cureus. 2022;14(1) 2. Polony G, Tamás L, Kecskeméti N. External auditory canal cholesteatoma causing simultaneous Bezold abscess and sinus thrombosis. Laryngoscope. 2021;131(4):E1282–5