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A 60-year-old woman presented with pulsatile tinnitus in the left ear. MRI and CT imaging suggested a soft-tissue mass in the middle ear. Exploratory tympanotomy and biopsy confirmed Schneiderian (inverted) papilloma. Endoscopic and radiological assessment showed no evidence of sinonasal lesions. The patient proceeded to mastoid surgery with removal of the ossicles for disease clearance. The small number of cases published to date of isolated middle ear inverted papilloma suggest a high recurrence and malignant transformation rate and aggressive management is therefore warranted.

Isolated Schneiderian papilloma of the middle ear cleft