Aural Polyp Research Articles

Clinical outcome of cats with suppurative otitis media and intact tympanum submitted to myringotomy: retrospective findings from 26 cases.

The efficacy of medical treatment associated with single myringotomy in cats with suppurative otitis media (OM) and intact tympanum was retrospectively evaluated. Patients' records were retrieved from cats with suppurative OM. Cats were included in this retrospective study based on fluid content within the tympanic cavity on imaging, intact tympanum on otoendoscopic examination and neutrophils on ear bulla exudate cytological examination. A total of 26 cats with middle ear suppurative otitis were included. Just over half of the cats (54%) presented bilateral involvement. Clinical signs included head tilt (13/26), otalgia (9/26), Horner's syndrome (7/26), external ear discharge (5/26), and nystagmus and facial paralysis (1/26). Cocci were identified on cytological examination in 18/40 samples and rods in 2/40. Bacterial culture results were positive in 15/40 samples, with Pseudomonas species (4/15), Pasteurella multocida (3/15), Staphylococcus felis (3/15), Staphylococcus schleiferi (2/15), Staphylococcus canis (2/15), Escherichia coli (2/15), Staphylococcus pseudintermedius (1/15) and Serratia marcesens (1/15) isolation. After myringotomy and gentle flushing of middle ear bullae (0.5-2 ml saline per ear), all cats were treated with oral corticosteroids and a 1-month course of systemic antibiotics according to sensitivity testing. In total, 19 (73%) cats were clinically healed 60-240 days after treatment. One cat was euthanased because of failure to eradicate a Pseudomonas species infection. Another cat died a few hours after the procedure. The five remaining cats were cured after ventral bulla osteotomy. OM without an aural polyp is a frequent diagnosis in cats, but data on medical treatment are scarce. This simple therapeutic technique, single myringotomy procedure and mild ear flushing, offers a practical, safe and efficient first-line treatment of suppurative OM with an intact tympanum in cats with or without neurological signs.

A Clinicopathological Study of Aural Polyps: A Retrospective Analysis in a Tertiary Care Hospital.

Introduction Aural polyps are a misnomer. Any lesion can present as a mass in the external auditory canal. Aural polyps are proliferation of the granulation tissue due to long standing inflammatory process with associated otalgia and otorrhea. Objectives To document the clinicoradiological presentations, intraoperative findings, and histopathological diagnosis of aural polyp, correlating them. Methods In our study 81 patients underwent treatment for aural polyps in the department of Ear, Nose, and Throat (ENT) from April 1997 to April 2022. Results were tabulated, a simple descriptive analysis was done using the Statistical Package Social Sciences software, and the results obtained were represented as percentages and presented in tables. Results The majority (38) of the patients presenting with aural polyps were diagnosed with mucosal and squamous type of CSOM, and 22 with simple granulation polyps. There were also 5 patients with malignant otitis externa, 3 patients had glomus tumors, 2 patients with retained foreign bodies, and 3 patients with brain herniation. We also identified aberrant internal carotid artery, high jugular bulb, one patient had facial nerve neuroma, one patient had polyp from the tragus diagnosed with tuberculosis, one patient with keratosis obturans, and one with exostosis. Conclusion A thorough detailed examination and mastoid exploration with radiological and histopathological evaluation is mandatory for better defining the definitive treatment. Utmost care and meticulousness are advised for the surgeons while dealing with aural polyps to avoid any complications.

The Role of Neutrophils and NETosis in Local Immunity of Feline Inflammatory Aural Polyps

The Role of Neutrophils and NETosis in Local Immunity of Feline Inflammatory Aural Polyps

Middle Ear Embryonal Rhabdomyosarcoma in a Five Years Old Child - A Rare Case Report

Rhabdomyosarcoma is the most common pediatric malignancy with a predilection for head and neck region. Embryonal Rhabdomyosarcoma is a variant of rhabdomyosarcoma which is extremely rare in middle ear. We present a case of middle year embryonal rhabdomyosarcoma in a five-year-old child who was treated as otitis media on first presentation and later misdiagnosed as a vascular aural polyp on histopathology.

Pilonidal sinus of external auditory canal as unpredicted lesion: rarest case presentation and review of literatures

BackgroundPilonidal sinus (PNS) is considered as a benign lesion of hair-bearing areas, particularly at the sacrococcygeal area. It is presented as a hole or tunnel in the skin. It may be filled with fluid or pus resulting in the formation of a cyst or abscess. Although PNS is a well-established lesion in general surgery as well as dermatology specialties by its occurrence at the sacrococcygeal region, but the surprising presentation of PNS is that at ENT specialty by its appearance at the external auditory canal (EAC), which is deemed unpredicted lesion at this particular region.Case presentationNine years female Libyan child has been presented with a history of persistent offensive bloody stained yellowish discolored left ear otorrhea a few months before her presentation. The local examination including the microscopic examination revealed evidences of a grayish-pinkish pedunculated polypoidal mass raised from the junction of the superior wall with the anterior wall of the EAC, at the site of the junction between the cartilaginous and bony portions of EAC. The temporal bone CT scan revealed evidences of radiolucent soft tissue density mass arising from the wall of the EAC at its anterior-superior junction, with the intact tympanic membrane as well as the middle ear cavity. This was most probably in favor of the suggestion of granulation tissue or aural polyp. The mass was completely excised as one piece from its pedicle and sent for histopathological evaluation, which was in favor of the diagnosis of PNS.ConclusionWe consider this case for reporting because of its scarcity and unexpected lesion at EAC. To the best of our knowledge, our case constitutes the second case of the EAC specifically, and the third case of external ear generally reported in the world. Thus, we tried to illustrate this unique and rare EAC lesion concerning how it is clinically as well as pathologically presented. In addition, we tried to review the literatures to elucidate whether this rare lesion has been reported before.

Evaluation of aural masses submitted as inflammatory polyps in 20 dogs (2000-2020).

Canine non-neoplastic aural polypoid masses (APMs) are uncommon, with few published studies. The aim of this retrospective study was to characterise the clinical presentation, diagnostic imaging and histopathological results for APMs submitted as aural inflammatory polyps (AIPs). Twenty dogs with APMs evaluated at a veterinary teaching hospital. Cases were selected by searching computerised medical records from 2000 to 2020, using keywords 'canine', 'aural/otic polyp' and 'aural/otic inflammatory mass'. Histological samples and medical records were reviewed. In 14 of 20 dogs, external ear canal masses were characterised by keratinised squamous epithelium with or without adnexa. Tympanic bulla origin was confirmed in four of 20 dogs by the presence of cuboidal to ciliated columnar epithelium, with or without squamous epithelium. The site of origin could not be determined in two dogs. Diagnostic imaging (MRI or CT) confirmed APM presence in 14 of 20 dogs. Otitis media was diagnosed in four of four tympanic bulla APMs and seven of 13 ear canal APMs. In 18 of 20 dogs, debulking, traction avulsion, and total ear canal ablation and bulla osteotomy led to APM resolution in two of eight, four of six and four of four dogs, respectively. Type of epithelium was a key feature in determining the APM origin, and interpretation in conjunction with video otoscopy and diagnostic imaging was crucial. Canine APMs more commonly arose from the ear canal. Tympanic bulla APMs and APMs of undetermined origin were comparable to feline AIPs. Regardless of APM origin site, debulking had the greatest likelihood of recurrence.

Middle Ear Primary Oncocytic Schneiderian Papilloma: A Case Report.

Introduction:Chronic otitis media is a significant health problem, but middle ear and mastoid neoplasms, either benign or malignant, are extremely rare.Case Report:Here is a report from a 51-year-old female who presented persistent otorrhea with an aural polyp. The patient was operated on with the probable diagnosis of cholesteatoma. During surgery, a fragile mass was discovered, and histopathologic examination reported the diagnosis of a primary oncocytic Schneiderian papilloma. Microscopically it has pseudostratified epithelium of columnar cell epithelium with eosinophilic granular cytoplasm and hyperchromatic nuclei. The treatment of choice for Schneiderian papillomas is complete surgical removal.Conclusions:Although very rare, oncocytic Schneiderian papilloma should be considered a differential diagnosis of ear neoplasms such as auditory canal polyps.

Pólipo aural inflamatório bilateral em um filhote de gato - relato de caso

Feline aural inflammatory polyps are non-neoplastic masses in the tympanic cavity or the Eustachian tube that can be observed in the ear canal of the cat and are a common cause of otitis externa and otitis media in young animals, with or without respiratory signs depending on the direction of polyp growth. Most of the polyps occurring in cats are unilateral. Otoscopy or video-otoscopy is necessary for its diagnosis, and treatment consists of the mechanical removal of the polyp and subsequent use of anti-inflammatory drugs. The aim of this paper was to report a case of bilateral inflammatory aural polyps in a kitten treated successfully by the minimally invasive technique of per-endoscopic trans-tympanic traction. A seven-month-old female mixed-breed cat, presenting bilateral ear discharge, was submitted to endoscopic examination of both ears and polypoid masses observed in each horizontal canal. Both polyps were grasped and pulled with a polypectomy snare through the otoendoscope. The patient received dexamethasone immediately after the procedure and a long-term oral corticosteroid protocol was established post-avulsion. It was concluded that otoendoscopy allowed an accurate and quick diagnosis, that the mass removal by per-endoscopic trans-tympanic traction was an effective treatment with no complications, and that bilateral occurrences could indicate a differential diagnosis, especially in young cats.

Causes of Middle Ear Aural Polyps in Adult Patients from Kut and Diwaniyah Cities in Iraq.

Aural polyps consider as one of the most notable progressive lesions of middle ear. Chronic otitis media can result in development of aural polyps that ascends from the tympanic cavity outwards to the external auditory canal, leading to tympanic membrane perforation and hearing loss. Morbidity and mortality are usually rare, however, failure of diagnosis or prolonged negligence by the patient could increase the likelihood of cholesteatoma or malignant squamous carcinoma. To investigate the causes of middle ear aural polyps in adult patients selected from Kut and Diwaniyah cities in Iraq. 40 patients which of those 14 males and 26 females were included in this study based upon the clinical manifestation of the illness and the suffering from a mass in the tympanic cavity, partial or complete hearing loss, otorrhea and dizziness. Otoscope was used to confirm location, shape, size of the polyps, and the status of the tympanic membrane. The mean age of the involved patients in the study was (44.65 ± 10.9) years. Age range was between (20-60) years. The highest frequency of patients with aural polyps was seen in patients at their third to fifth decade of age. There were 14(35%) men, and 26(65%) women. Findings showed that mean age of men was (44.07 ± 13.7) years, and women was (44.96 ± 9.4) years, (p=0.405). Clinical examination revealed 27(67.5%) patients with cholesteatoma, 10(25%) with inflamed mass in the middle ear, and 3(7.5%) were with cancerous tumor. Correlative analysis showed no significant correlation between age and causes of aural polyps (p=0.664), and no correlation between sex and causes of aural polyps (p=0.524). Aural polyps are rare disease in Iraqi patients. However, treating and monitoring patients with ongoing chronic otitis media is essential in preventing the development of aural masses in middle ear and other complications if left untreated. Early diagnosis and treatment can prevent reoccurrence and other complications.

Atypical presentation of langerhans cell histiocytosis of temporal bone in a toddler

Ever since Langerhans cell histiocytosis (LCH) was first described in 1865, mystery revolving around its cause and pathogenesis remains, although most agree that LCH is either a reactive or neoplastic process. We aim to highlight the importance of careful investigations of common presentation, which may lead to the diagnosis and treatment in a toddler. We report a case of LCH of the temporal bone with an atypical presentation in a toddler, which led to delayed diagnosis. The patient presented with a vague preauricular swelling and aural polyp. Imaging and histopathological examination of the biopsy revealed temporal bone LCH, and the child was referred to the pediatric oncology unit and successfully treated. This case clearly demonstrates the highly diversified clinical manifestation of LCH and the high level of suspicion required to diagnose it. We describe the challenge faced in managing this rare entity.

External Auditory Canal Cholesteatoma: Clinical and Radiological Features.

Introduction External auditory canal cholesteatoma (EACC) is often misdiagnosed. Objectives To outline the clinical presentation of EACC, and to describe its radiological findings on high-resolution computed tomography (HRCT) of the temporal bone. Methods The clinical records of all patients diagnosed with EACC from April 2017 to March 2020 in a tertiary care center were retrospectively reviewed. The clinical presentation, the findings on the HRCT of the temporal bone, and the treatment provided were analyzed. Results A total of 9 patients, 7 males and 2 females, with a mean age of 30 years, were diagnosed with primary EACC. Six patients presented with otorrhoea, three, with otalgia, three. with hearing loss, and one with facial palsy. Some patients had multiple symptoms. The most common findings on otomicroscopy were destruction of the posterior and inferior canal walls, with cholesteatoma and intact tympanic membrane (six patients). Two patients had aural polyp, and one had a narrow ear canal due to sagging of the posterior canal wall. On HRCT, all nine patients showed soft-tissue density in the external auditory canal with erosion of the canal wall. The disease extended to the mastoid in eight cases, and to the cavity of the middle ear in one. There were three cases of dehiscence of the facial canal. Dehiscence of the dural and sinus plates was observed in two cases each. Eight patients underwent mastoidectomy, and one underwent debridement with canalplasty. Conclusion Review of the clinical and radiological findings is essential to reduce the rate of misdiagnosis.

Aural polyps: What's behind them?

Introduction: Polyps in the external auditory canal (EAC) may be present due to inflammation induced by chronic otitis media. In many cases, the type of underlying otitis media is a cholesteatoma. Aim: The aim of this article is to determine the etiology of EAC polyps in patients referred to the Otology Division of a tertiary hospital in south Brazil. Materials and Methods: Cross-sectional study was conducted with a cohort of patients with otologic diseases who were evaluated from July 2001 to December 2020. Patients with unilateral or bilateral aural polyps underwent anamnesis and recorded video-otoscopy and had their online medical chart reviewed. Results: Of the 2432 patients evaluated, 133 (5.4%) had a polyp in the external auditory canal. Of those, 53 were excluded, leaving a final sample of 81 patients (3.3%). Discussion: Middle ear cholesteatoma (MEC) and non-cholesteatomatous chronic otitis media (NCCOM) were responsible for 86.3% of all polyps evaluated and the majority of diagnoses were established through surgery (76.5%). Conclusion: Symptoms associated with polyps and their aspect do not reveal the most probable etiologies making imaging exams, biopsy and surgery necessary steps in aural polyp investigation.

Endoscopic Versus Microscopic Canal Wall Up Surgery for Cholesteatoma: A Diffusion-Weighted Magnetic Resonance Imaging Post-Operative Study

Background: Cholesteatoma is a surgical disease for which the primary universally accepted goal is total eradication of cholesteatoma to obtain a safe and dry ear. The second objective is restoration or maintaining the hearing. Objective: This study was aimed to solve the problem of residual cholesteatoma and decrease the problem of large mastoid cavities and to increase the learning curve of endoscopic ear surgery. Patients and Methods: non-randomized controlled trial study performed in Otolaryngology, Head and Neck Surgery Departments, Zagazig University Hospitals in the period from February 2018 to February 2021 on 30 patients suffering from middle ear cholesteatoma. Otoendoscopic evaluation were used for detection of the presence of attic perforation, posterosuperior perforation, aural polyps and, whitish shadow behind intact tympanic membrane. All patients were operated under general anesthesia with controlled hypotensive technique. Results: After 1 year of follow-up in 15 patients using endoscopic approach and 15 patients using microscopic approach, the recidivistic cholesteatoma was found in 6.7% in endoscopic group while it was 20% in microscopic group. Conclusions: It could be concluded that the use of an endoscope provided important benefits to patients with middle ear cholesteatoma and offer superior visualization than microscope.

Per-Endoscopic Trans-Tympanic Traction Treatment of an Aural Inflammatory Polyp in a Cat

Per-Endoscopic Trans-Tympanic Traction Treatment of an Aural Inflammatory Polyp in a Cat

Capillary Hemangioma of the External Auditory Canal Extending to Middle Ear and Mastoid Cavity: A Rare Case Report with Review of Literature.

Capillary hemangioma involving external auditory canal, middle ear and mastoid cavity is a very rare entity. Due to infrequent incidence but multiple overlapping clinical and radiological features amongst some common middle ear pathologies this benign vascular tumour often can be misdiagnosed. Histopathological report helps us to get definitive diagnosis. 40years old female presented with diminished hearing and mass in right ear cavity for last 3years. The otoscopic examination of right ear showed a pinkish polypoidal mass at the external auditory canal and tympanic membrane could not be visualized. Patient had a history of cortical mastoidectomy 2years back for the similar problem. HRCT temporal bone revealed a single cavity with soft tissue density content in right mastoid cavity which was extending into right middle ear and external ear. Contrast Enhanced MRI showed a long polypoidal heterogeneously but strong enhancing T2 and STIR hyperintense lesion within mastoid antrum extending into middle ear cavity and external auditory canal forming an aural polyp. Excision of the mass was done by canal wall down mastoidectomy and also type IIIc tympanoplasty performed in same sitting. There is no recurrence noted after 6months of follow up and hearing improvement noticed. Capillary haemangioma of mastoid antrum extending to middle ear and external auditory canal requires surgical excision as preferred treatment modality, pre-operative imaging guide us to choose the preferred surgical approaches.

Foreign Body in External Auditory Canal Masquerading as Middle Ear Polyp.

Aural Polyps are usually inflammatory in nature however they may rarely be a manifestation of a more severe disease. Aural Polyps that are resistant to conservative management point towards inflammatory polyp with underlying chronic otitis media.Rarely it may be due to foreign body or neoplastic lesions. We present a case of foreign body in external auditory canal masquerading as a middle ear polyp.

Embryonal Rhabdomyosarcoma in Middle Ear: A Rare Case Report

Rhabdomyosarcoma (RMS) in middle ear and mastoid are uncommon. Presentation of RMS in these sites include purulent or blood stained discharge, polypoidal mass and granulation tissue. Clinical diagnosis may be delayed due to similar presentation as Chronic Suppurative Otitis Media (CSOM). Authors herein report a case of six-year-old male patient, who presented with a blood stained discharge from right ear for 15 days. On otoscopic examination, a polypoidal mass in external auditory canal was identified. A history of ruptured right tympanic membrane with occasional discharge for two years had been given. Clinical diagnosis of CSOM with aural polyp had been made. Radiographically, it was a soft tissue lesion with poorly defined margins. There were no bony erosions with minimal collection in right middle ear cavity. On routine histopathological examination diagnosis of round cell tumour had been made. On Immunohistochemistry (IHC), tumour was immunoreactive for desmin and vimentin, while negative for Cytokeratin (CK), Leukocyte Common Antigen (LCA), chromogranin and synaptophysin. Tumour was diagnosed as RMS (Embryonal type). This case report shows importance of early diagnosis of RMS in middle ear, which is often delayed and misdiagnosed as CSOM. Delayed diagnosis may lead to, facial nerve involvement, local meningeal involvement and distant metastasis. Histopathological examination and IHC e.g., desmin positivity are the mainstay of diagnosis.

Feline bilateral inflammatory aural polyps: a descriptive retrospective study

Feline inflammatory aural polyps (IP) have been reported as solitary growths, yet bilateral polyps may occur more commonly than described previously. To identify the prevalence and risk factors associated with bilateral feline IP within a population of cats evaluated at a veterinary teaching hospital over a 10year period. Twenty-five cats with histologically confirmed IP. A retrospective study was performed by searching computerized medical records of cats seen at The University of Tennessee Veterinary Teaching Hospital from 2005 to 2015. Keywords used for the search included "feline polyp", "ventral bulla osteotomy", "inflammatory polyp ear canal" and "nasopharyngeal polyp". Cats were separated into groups with unilateral or bilateral disease. Six of 25 (24%) cats had bilateral IP. Twelve cats had computed tomography performed (four of six with bilateral IP; eight of 19 with unilateral IP). Clinical signs, history of upper respiratory infection, post-treatment complications, and IP recurrence with and without local and systemic steroid administration were studied between groups and no differences were identified. In four of six cats with bilateral disease, the second polyp was identified with advanced imaging performed at the time of referral. These findings demonstrate that bilateral IP occur more frequently than reported previously and establish a prevalence for bilateral IP. These findings also highlight the value of advanced imaging techniques in diagnosing bilateral IP.

Aural Polyp with Chronic Suppurative Otitis Media Dissembling Glomus Tympanicum

Glomus tumors are benign, slow-growing tumors of the temporal bone and most commonly present as hearing loss and tinnitus with an intact tympanic membrane. Most of the time, the diagnosis is delayed and sometimes missed as it is associated with chronic suppurative otitis media (CSOM). History of the disease and proper clinical examination followed by radiological investigations are required for diagnosis and management. Surgery is the treatment of choice, but larger tumors may require other modalities of treatment. Histopathology with immunohistochemistry confirms the diagnosis. We report a case of 63-year-old female patient with glomus tympanicum associated with CSOM. She had symptoms for the last 10 years, but the diagnosis was missed because of coexisting CSOM. She was diagnosed with the help of radiological investigative modalities. She underwent mastoidectomy with complete excision of tumor. She was managed successfully without recurrence. Glomus tumor is an uncommon disease in the middle ear, and sometimes, its diagnosis is missed because of the presence of other diseases. Radiology helps in diagnosis and management of the tumor. Complete surgical excision with regular follow-up prevents recurrence.

Clinicopathological study on aural polyp

<p class="abstract"><strong>Background:</strong> The study of the aural polyp was undertaken to emphasize various causes of the aural polyp and to highlight the importance of histopathology in the management of these cases.</p><p class="abstract"><strong>Methods:</strong> 50 patients who attended the ENT outpatient department with aural polyp were taken for the study. Aural polypectomy was done after clinical, radiological evaluation and examination under the microscope. Tissue was sent for histopathological examination. </p><p class="abstract"><strong>Results:</strong> The most common lesion was found to be Inflammatory polyp (50%), followed by cholesteatoma (30%), chronic non-specific inflammation (10%). Others included abscess (6%). One case each of squamous cell carcinoma and glomus were also reported. </p><p class="abstract"><strong>Conclusions:</strong> Aural polypectomy, followed by histopathological examination, may uncover serious disease processes and will assist in planning further management in extensive diseases. Though inflammatory polyp is the most common cause, vascular and malignant tumors should also be considered while evaluating the case.</p>