We report a case of primary middle ear lipoma diagnosed in the right e
ar of a five-year-old child with concurrent bilateral middle ear effus
ions. The lipoma occupied a site favoured by congenital cholesteatoma
and was occlusive to the eustachian tube contributing to its dysfuncti
on. This is the first case of de novo middle ear lipoma diagnosed in t
he UK, and the third in world literature. Our CT scans are suggestive
of a similar but smaller lesion in the left ear of the same child.