Canal Cholesteatoma Research Articles

Primary ear canal cholesteatoma in children without canal stenosis

Primary ear canal cholesteatoma in children without canal stenosis

Cholesteatoma debridement for primary external auditory canal cholesteatoma with non-extensive bone erosion

Background: External auditory canal (EAC) cholesteatoma (EACC) is rare and its treatment for different lesions has not yet been standardized.Objective: This study aimed to explore the clinical features of EACC with bone erosion, and to assess the curative effect of initial complete cholesteatoma debridement (ICCD).Material and methods: Clinical characteristics and prognosis of 41 ears were analyzed retrospectively.Results: The bone erosion of the EAC was most commonly affected on the posterior wall (37 ears), next by the inferior wall (34 ears), the anterior wall (30 ears) and the superior wall (23 ears). Hearing loss (36 ears) was the most common symptom, followed by otalgia (33 ears), otorrhea (18 ears), tinnitus (11 ears) and pruritus (3 ears). The hearing impairment of mean air conduction and air-bone gaps were improved from 39.2 dB to 22.7 dB, and 23.5 dB to 7.1 dB after the ICCD procedure, respectively. Four ears presented recurrence during the follow-up time and accepted a revision-debridement.Conclusion and significance: The ICCD might be applicable in the treatment of patients in the early stages and with non-extensive bone defect; however, close and long-term surveillance is essential and serial debridement is probable.

Clinical features and surgical treatment of external auditory canal cholesteatoma in 149 cases

Objective:The aim of this study is to explore the clinical characteristics, surgical management and treatment results of type Ⅰto type Ⅳ external auditory canal cholesteatoma（EACC）. Method:One hundred and forty-nine patients（150 ears） with EACC underwent different surgical approach according to the classification of EACC and the lesion range: ① 44 ears: external auditory canal lesion resection with or without reconstruction of external auditory canal ② 23 ears: external auditory canal lesion resection with reconstruction of external auditory canal and the tympanoplasty（TypesⅠto Ⅲ）; ③ 32 ears: external auditory canal lesion resection with reconstruction of external auditory canal and modified mastoidectomy and reconstruction of the posterior wall of external auditory canal; ④ 28 ears: external auditory canal lesion resection with reconstruction of external auditory canal and tympanoplasty（Types Ⅰ to Ⅲ） and modified mastoidectomy and reconstruction of the posterior wall of external auditory canal; ⑤12 ears: canal wall down mastoidectomy （CWD） with plasty of the cavity of auricular concha; ⑥ 11 ears: epitympanum dectomy and reconstruction with tympanoplasty. Result:In the 150 ears, there were 38 ears classified as Type Ⅰ, 52 as Type Ⅱ, 58 as Type Ⅲ and 2 as Type Ⅳ based on the Shin classification. All patients were followed up for more than half a year. The postoperative outcomes were satisfactory with low rate of cholesteatoma recurrence and the hearing was improved to varying degrees. Conclusion:Base on the variety of lesions, the surgical treatment method of choice depends on the extent of the lesion. Effective postoperative follow-up can reduce recurrence and avoid the second operation.

Case series on external auditory canal cholesteatoma: an entity often misdiagnosed

<p class="abstract">External auditory canal cholesteatoma (EACC) is a rare disease. EACC presents with chronic dull aching pain with normal hearing. It is diagnosed by clinical examination and radiological investigation. Due to its rarity it is important to differentiate it from other external ear conditions. We prospectively analysed four cases of cholesteatoma of the external auditory canal in a period of 18 months. All of our patients underwent surgery. In three cases, the cholesteatoma was restricted to the external auditory canal, while in one case it was extending into the antrum. A proper clinical examination with radiological investigations will be helpful in the diagnosis and for proper management of the disease.</p>

Single stage cochlear implantation in radical mastoid cavity- a surgical dilemma

Objective: To describe the potential problems of cochlear implantation in mastoid cavity with possibilities of extrusion of electrode array by breakdown of epithelial lining or flap cover recurrent cholesteatoma and spread of infection to the implant. The issues with surgical management and subsequent follow up is discussed. Methods: In a Series of 170 Cochlear Implantations at our centre, four patients had Cochlear Implantation with Blind sac closure, complete removal of epithelium from the radical mastoid cavity, obliteration of the cavity with temporoparietal fascia flap and electrode insertion. Follow up ranging from 21 months up to 84 months is available. One patient during follow up had to undergo re implantation due to extrusion of the electrodes. Results: All the patients had good outcome regarding hearing improvement. One of the patients had to undergo exploration and re implantation of electrodes due to extrusion of electrodes through the external auditory canal. This patient had a canal cholesteatoma. Discussion: An important issue in single stage procedure is ensuring complete removal of fibro epithelial lining of the cavity. The advantage is cost reduction and minimizes the need for multiple general anesthesia. A follow up CT scan at regular intervals is required to detect recurrence. Conclusions: The patients undergoing cochlear implantation in a radical mastoid cavity require intensive follow up with computerized tomography to detect recidivism, Single stage cochlear implantation in radical mastoid cavity is an appropriate therapeutic decision by the cochlear implant surgeon.

Canal cholesteatoma in canal stenosis: a case report

Purpose :
 We present a-12-year old female with canal stenosis and canal cholesteatoma. We discuss the clinical, radiological and treatment option for canal cholesteatoma in canal stenosis
 Discussion :
 Congenital canal atresia is a failure of the development of the external auditory canal which comprises anomalies of variable severity involving pinna, external acoustic canal, middle ear structures and rarely inner ear leading to hearing impairment. Congenital canal stenosis is considered to be a subset of congenital canal atresia. This malformation results in mild to severe conductive hearing loss. Furthermore, risk of cholesteatoma increased when it is associated with stenotic ear. Radiological evaluation in the form of HRCT scan of temporal bones should always be done in these patients during their initial presentation and surgery should be planned accordingly. Their presence should be rule out prior any corrective surgery.
 Conclusion :
 Although the incidence of canal cholesteatoma is rare in congenital canal stenosis, all patients presenting with canal atresia or stenosis should be evaluated thoroughly due to their potential to develop cholesteatoma as it may be challenging to treat at an advanced stage in view of morbid complications.

Colesteatoma de conducto auditivo externo: estudio de una serie de casos

Introducción y objetivos: El colesteatoma de conducto auditivo externo (CCAE) es un proceso patológico poco frecuente, caracterizado por la invasión de tejido escamoso en un área del canal auditivo, que progresa hasta la destrucción ósea. Debido a la escasez de casos publicados hemos considerado de utilidad esta revisión. Material y métodos: Estudio prospectivo y observacional desde el año 2000, de 18 pacientes diagnosticados clínicamente de CCAE en nuestro servicio de ORL. Resultados: El porcentaje de hombres y mujeres es similar, con una edad media de diagnóstico de 60 años. La localización más frecuente es posteroinferior y en la mayor parte de casos el origen es primario. La otalgia, la otorrea y la hipoacusia fueron los síntomas principales, siendo menos habitual el prurito y excepcional la debilidad facial. En general el tratamiento es conservador, pero resultó necesario el abordaje quirúrgico en un tercio de pacientes mediante canaloplastia, siguiendo el esquema expuesto, o la mastoidectomía, en función de la extensión de las lesiones. Conclusiones: Aunque desconocemos los mecanismos patogénicos responsables de la formación y desarrollo del CCAE, la inclusión de queratina entre el epitelio y el hueso, con la participación del periostio, parecen ser los desencadenantes del proceso. El diagnóstico es clínico y su extensión determina el empleo de un tratamiento local o quirúrgico, que suele ser resolutivo.

Spontaneous External Auditory Canal Cholesteatoma: Case Series and Review of Literature

External auditory canal cholesteatoma is a rare disease. Main symptoms of this entity are ear discharge and dull chronic ear pain and significant findings are bony erosion of the external canal with keratin debris accumulation. Inadequate diagnosis and delay in the treatment of this condition can leads to serious complications. We are presenting our experience of eight patients of spontaneous EACC treated by surgical management. As the spontaneous EACC is a rare condition, the aim of the study is to share the experience of diagnosis and management of spontaneous EACC.

Osteoma of external auditory canal associated with external auditory canal cholesteatoma and exuberant granulation tissue in mastoid air cell system: a rare association.

Osteoma of EAC is a rare tumour. Cholesteatoma of EAC associated with osteoma is consequence of osteoma of EAC. Its incidence is rare and very few cases have been reported in the literature. Its association with exuberant granulation tissue in the mastoid air cell system without extension of Cholesteatoma into middle ear cleft is even rare. This association has been reported for the first time as evident from review of literature.

Cartilage Fascia Composite Canalplasty for External Auditory Canal Cholesteatoma: Case Analysis and Long-term Surgical Results.

To analyze surgical outcomes of cartilage-fascia composite canalplasty (CFCC) for external auditory canal cholesteatoma (EACC). Retrospective case review study. Tertiary referral center. A total of 13 patients with EACC (n = 14 ears due to one patient with bilateral EACC). Surgical method of CFCC using well designed-conchal cartilage and temporalis muscle fascia after complete removal of EACC. Clinical characteristics and EACC stages were determined by oto-endoscopic examination and computed tomography (CT) findings. The surgical results of CFCC were analyzed. The median age of patients was 43 years (range, 12-75 yr), with a male to female ratio of 6 to 7. EACC stages were from II to IV. Cortical bone erosion in the inferior part of the bony EAC was the most common finding. All patients had satisfactory results: no more ear symptoms related with cholesteatoma and no need of dressing. Postoperative hearing gain was observed in four patients. No complications or recurrence occurred during the mean follow-up period of 34.4 months. Surgical technique of CFCC was effective for EACC not responding to conservative management.

Postauricular abscess: An uncommon presentation of keratosis obturans

Keratosis obturans (KO) is a rare disease involving the bony external auditory canal due to hyperkeratosis of epidermis and disturbance in the epithelial migration process resulting in deafness, otalgia, and inflammation of the ear canal skin. Complications are extremely rare. Here, we present a case of KO in an elderly female presenting as a postauricular abscess, an unreported occurrence first of its kind in the literature. A 67-year-old female patient presented with complaints of dull aching pain and decreased hearing in the left ear for 1 month and swelling behind and above the left ear for 2 weeks. On examination, there was impacted wax in the left external auditory canal and the tympanic membrane was not visualized. A high-resolution computed tomography of the temporal bone reported left otitis externa with soft-tissue density with fat strands in the left postauricular region. The patient underwent examination under microscope, followed by debridement and a subsequent cortical mastoidectomy. Histopathology confirmed the diagnosis of KO. KO is an uncommon condition caused due to occlusion of external auditory canal by desquamated keratinous plug. It is important to differentiate it with other common conditions, including necrotizing otitis externa, canal cholesteatoma, osteoradionecrosis of the external auditory meatus, and tumors of the external auditory meatus. Extracranial complications are rare, including extensive bony erosion and automastoidectomy with no intracranial complications reported till date. KO is a relatively rare condition more commonly seen in the younger age group, and postauricular abscess as a complication of KO has not been reported till date. We thus highlight the importance of awareness of such rare conditions of the external auditory canal, promoting early diagnosis, prompt treatment, and successful prevention of complications.

Clinical Presentation of Congenital Cholesteatoma of the External Auditory Canal in Goldenhar Syndrome: A Case Series

Background: Goldenhar Syndrome, also called Oculoauricular Vertebral Dysplasia, includes abnormalities of the first and second branchial arches. Ear abnormalities are present in approximately 92% of those with Goldenhar Syndrome [1]. There is a wide spectrum for ear anomalies; they can range from preauricular tags and pits, microtia, external auditory canal (EAC) atresia, ossicular malformations, and facial nerve hypoplasia, which can lead to an array of clinical findings [5]. Hearing loss is an unfortunate consequence of these clinical findings, and often results in subsequent speech and language delays [4]. Despite the widely reported auricular and audiologic manifestations of this disease, a review of the literature revealed no detailed description or analysis of congenital canal cholesteatoma specifically in this patient population. Objective: This study aims to characterize congenital external auditory canal cholesteatoma as a feature of Goldenhar Syndrome. Method: A retrospective case series was conducted with patients seen at the UNC Craniofacial Center in Chapel Hill, NC. Inclusion criteria included patients with a diagnosis of Goldenhar Syndrome also found to have congenital cholesteatoma necessitating surgery. A total of three patients were identified who met inclusion criteria. Results: Three patients with Goldenhar Syndrome were identified who also had congenital external auditory canal cholesteatoma. All three patients underwent surgical management of their disease. Conclusion: Congenital external auditory canal cholesteatoma appears to be a feature of Goldenhar Syndrome not widely described in current literature. Though rare, it is a relevant disease process with significant clinical implications for both hearing as well as speech and language development. Awareness of this condition can thus help guide practitioners in the care of these patients.

Clinical analysis of pediatric primary external auditory canal cholesteatoma

ObjectivePediatric primary external auditory canal cholesteatoma (EACC) is a rare disease. The present study aimed to explore the clinical features and prognosis of this disease. MethodsClinical data of 41 ears with pediatric primary EACC were collected, and the clinical characteristics and prognosis were analyzed in this retrospective study. ResultsA total of 35 patients (median age of 13 years) were recruited in this study. Of these, 13 suffered on the left side and 16 on the other side, while 6 suffered on the bilateral ears. A total of 35 ears had hearing loss, 26 had otalgia, 15 had otorrhea, 12 had tinnitus, and 4 had pruritus. The median course of the disease was 1 month. The bone destruction of the external auditory canal (EAC) was located on the inferior wall of 20 ears, the posterior wall of 22 ears, the superior wall of 15 ears, and the anterior wall of 15 ears. According to Shin's stages, 24 ears were in stage I, 2 in stage II, 15 in stage III. A total of 40 ears underwent transcanal cholesteatoma removal (TCR) and 1 underwent both TCR and tympanoplasty. Finally, 33 ears were followed up postoperatively, and only 1 ear presented recurrence. ConclusionThe posterior wall of the EAC is the most commonly affected wall, and the involvement of multiple walls is common. Due to the remodeling of the EAC bone in pediatric patients, the high stage lesions can be treated by minimally invasive surgical debridement combined with a close follow-up postoperatively.

Cholesteatoma of the External Auditory Canal: Review of Staging and Surgical Strategy.

External auditory canal cholesteatomas (EACC) is insidious in nature and rare entity. There are only few case series on EACCs and surgical strategy is not standardized. 1) To elucidate etiology of EACC and cardinal features. 2) To suggest a practical staging of EACC. 3) To enumerate surgical management according to stage of EACC. Retrospective study in a quaternary referral center of 31 consecutive cases of EACC. Thirty-one patients with EACC were reviewed. Unilateral otorrhea 19 (61.2%), hearing loss 22 (70.9%), and otalgia 8 (25.8%) are cardinal symptoms. Sixteen primary and 15 secondary EACCs were treated. Bone erosion was observed in 20 cases. In the present series, stage III = 12 (38.7%), stage II = 8 (25.8%), stage I = 11 (35.4%) underwent definitive treatment by surgery. Canalplasty with reconstruction was done in 19 cases of stages I and II. Of 12 cases in stage III, 3 cases underwent canalplasty with reconstruction. Subtotal petrosectomy was done in five cases. Intact canal wall mastoidectomy with canalplasty in two cases and radical mastoidectomy in two cases. Fascia, cartilage, muscle, and bone dust were used for reconstruction. Median follow-up period was 6 years and no recurrence of cholesteatoma was observed. EACC is unique entity. Intraoperative and radiological findings assist in correct and practical staging of EACC. Late stage presentations of EACC are common. Definitive surgical treatment in our series avoided recurrence of cholesteatoma.

The clinical characteristics of pediatric external auditory canal keratosis obturans

Objective: To analyze the clinical characteristics of pediatric external auditory canalkeratosis obturans(KO). Method: Retrospective analyze the clinical data of twenty-three patients were diagnosed with external auditory canal cholesteatoma(EACC). Their chief complaint, the course of the disease, clinical characteristics,CT manifestations,surgical procedure and prognosis were retrospectively analyzed. The clinical characteristics between EACC and KO were compared.Result: Twenty cases(22 ears) were eventually diagnosed as KO. Among them, 2 cases were bilaterally involved. In the remaining unilateral cases, right ear was involved in 11 cases and left ear in 7 cases. All patients complained otalgia(100%). Purulent otorrhea was found in 17 ears(77.3%), and hearing loss withpurulent otorrhea in 3 ears(13.6%). Otoscopic examination found 17 ear with granulation(77.3%).CT scan found deformation of the osseous ear canal and displacement of the tympanic membrane because of compression in 18 ears(81.8%), and the bony canal was absorpt because of pression in 7 cases(38.9%).All patients underwent otoendoscopic operation,and tympanic membrane perforation was found in 4 cases.Postoperative pathologic examination results were keratin epithelial. Conclusion: EACC is easily confused with KO. KO should be considered in the following circumstances: patient who complained of ear pain, ear granulation with purulent discharge, or circinate deformation of the osseous ear canal and displacement of the tympanic membrane in CT scan.

Clinical Characteristics of External Auditory Canal Cholesteatoma Associated with a History of Long-term Bisphosphonate Therapy

Clinical Characteristics of External Auditory Canal Cholesteatoma Associated with a History of Long-term Bisphosphonate Therapy

Imaging in autoimmune inner-ear disease and endolymphatic hydrops, bone cement for improving hearing outcomes in stapes surgery, and the reporting of results. External ear canal cholesteatoma: a hypothesis

Imaging in autoimmune inner-ear disease and endolymphatic hydrops, bone cement for improving hearing outcomes in stapes surgery, and the reporting of results. External ear canal cholesteatoma: a hypothesis

Surgical treatment of external auricular cholesteatoma involving tympanum and papilloma

Objective:To explore the operation treatments and their outcomes of external auditory canal cholesteatomas involving the tympanic cavity and mastoid process. Method:Forty-two patients (45 ears) with external auditory canal cholesteatomas were included in this study who were operated. All lesions invaded the tympanic cavity and mastoid process. Excision of cholesteatoma, external auditory canal angioplasty and concha formation were performed. Ossicular chain reconstruction was performed in 3 ears. Mastoidectomy with close technique were performed in 4 ears. Open radical mastoidectomy was performed in 5 ears. Posterior bone-wall of auricular meatus reconstruction was performed in 3 ears. Tympanoplasty was performed in 21 ears. Pure tone audiogram and aural endoscope were carried out after the operation (3 months, 6months, 1 year, 2 years, 3 years…). Result:Stricture of external auditory meatus were occured in 2 ears in 2 and 3 months after surgery respectively. Cholesteatoma recurrence was observed in 2 ears in 1 year after operation. Wet ear was observed in 1 patient and then another operation was performed after 7 months. Besides the patients above, the epitheliums of the cavity were well in all other patients with complete tympanic membranes. Hearing was improved in all patients (hearing by air conduction:5－30 dB HL). Conclusion:According to the range of the external auditory canal cholesteatoma, we took different operation methods including tympanoplasty, open or close radical mastoidectomy and reconstruction of posterior wall of external auditory canal etc. Those methods, including external auditory canal angioplasty, cavity plasty of concha and skin grafting of external auditory canal, could help to prevent scar formation and stricture of external auditory canal, prevent cholesteatoma recurrence and improve hearing.

External auditory canal cholesteatoma and benign necrotising otitis externa: clinical study of 95 cases in the Capital Region of Denmark.

To identify epidemiological and pathophysiological factors, and treatment strategies, in external auditory canal cholesteatoma and benign necrotising otitis externa. A retrospective case study was conducted of patients suffering from external auditory canal cholesteatoma and benign necrotising otitis externa admitted to tertiary hospitals, in the Capital Region of Denmark, over a five-year period. Eighty-three patients (95 ears) with external auditory canal cholesteatoma or benign necrotising otitis externa were identified. A minimum incidence rate of 0.97 per 100 000 inhabitants per year was demonstrated. Sixty-eight per cent of cases had a history of smoking. Most lesions (74 per cent) were localised in the floor of the ear canal. Treatment time was 3.2 months for patients who had surgery and 6.0 months for those who received conservative treatment. It is suggested that external auditory canal cholesteatoma and benign necrotising otitis externa are in fact the same disease, and therefore the diagnosis of external auditory canal cholesteatoma should be changed to benign necrotising otitis externa. Microangiopathy has a leading role in the aetiology. Surgery should be conducted in most cases.

Clinical Characteristics and Treatment Outcomes for Patients With External Auditory Canal Cholesteatoma.

We aimed to evaluate the clinical features and treatment outcomes for patients with idiopathic and secondary external auditory canal cholesteatoma (EACC), and to validate the treatment strategy from the perspective of hearing as well as etiology and staging. Retrospective case series. Tertiary referral center and affiliated hospitals. Fifty-eight patients with idiopathic EACC and 14 patients with secondary EACC. Conservative management and surgery. Air conduction (AC) pure-tone averages (PTAs) and mean air-bone gaps (ABGs). There were no significant differences between hearing values before and after conservative management for idiopathic EACC patients with stages I-III, indicating that hearing abilities were preserved. For idiopathic EACC patients with stage IV disease treated with surgery, the AC PTA threshold and mean ABG significantly improved from a preoperative value of 60.3 dB HL to a postoperative value of 32.4 dB HL (p = 0.013), and from 34.3 to 9.5 dB HL (p < 0.001), respectively. For secondary EACC, the AC PTA threshold and mean ABG significantly improved from a preoperative value of 49.5 dB HL to a postoperative value of 23.2 dB HL (p < 0.001), and from 31.4 to 6.7 dB HL (p < 0.001), respectively. The treatment modalities should be selected based on the perspective of hearing as well as the extent of disease and etiology. The early lesions can be treated conservatively, whereas the advanced lesions or cases refractory to conservative management require complete surgical removal of EACC.