Persistent otorrhea following radical mastoidectomy is a challenging postoperative complication, most commonly attributed to residual cholesteatoma, chronic infection, poor cavity drainage. Foreign-body reactions caused by retained surgical materials represent an exceptionally rare etiology and may remain undiagnosed despite repeated medical treatment and negative imaging studies. A 50 year old woman presented with persistent foul smelling purulent otorrhea from the right ear. She had undergone two previous radical mastoidectomies—the first seven years earlier, and a revision procedure two years later for recurrent disease. In the month preceding referral, continuous otorrhea failed to respond to repeated courses of topical and systemic antibiotics. High resolution computed tomography (HRCT) of the temporal bone showed no evidence of recurrent cholesteatoma or significant mastoid opacification. Conservative management with microscopic cleaning using 2% hydrogen peroxide and topical ciprofloxacin was unsuccessful. Revision surgery was undertaken. Exploration of the mastoid cavity revealed only minimal granulation tissue and mucosal thickening, without cholesteatoma. During revision meatoplasty, retained mesh fibers were unexpectedly identified beneath the posterior skin flap, extending 2–3 cm into the ossified mastoid bone. Complete excision of the mesh and surrounding inflammatory tissue was performed, along with repair of a small tympanic membrane perforation. The cavity was packed with Gelfoam. Otorrhea ceased completely within three weeks postoperatively.Retained surgical mesh should be considered in the differential diagnosis of chronic refractory otorrhea in patients with a history of mastoid surgery, particularly when imaging is inconclusive and conventional treatment fails.