Background: Metastases to the temporal bone are exceedingly rare, representing <0.2% of all head and neck tumors. The most common primary malignancies are from breast, lung, prostate and skin. Given the rarity of temporal bone metastases and paucity of such case reports in the literature, the dissemination of a diagnostic approach is a worthwhile venture. Case Report: Here we describe a patient with known metastatic adenocarcinoma of the descending colon presenting with unilateral aural fullness, hearing loss and ataxia. Radiographic investigations revealed a soft tissue mass within the mastoid bone, and biopsy confirmed metastatic colorectal adenocarcinoma. The patient’s disease progressed over time, causing facial paralysis, and eventually her demise. Conclusion: This unique and uncommon case highlights the importance of thoroughly investigating patients with known malignancy who present with unilateral otologic and vestibular symptoms.