In this case report, we describe the rare case of an idiopathic mastoid osteoma. A 40 year old woman complained of tenderness over her right mastoid during exercise and changes in head position. Medical treatment was initially offered with topical corticosteroids, capsaicin, and conservative cervical physical therapy. When her symptoms did not ameliorate, surgical management was then offered. Appropriate surgical planning included computed tomography with threedimensional reconstructions. A mastoidectomy through a postauricular incision for resection was then performed. The osteoma was then removed en bloc with final pathology consistent with a benign compact osteoma of the right mastoid.
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