External Auditory Canal Cholesteatoma Research Articles

Endoscopic Cartilage Modified Inlay Technique With Preserving External Auditory Canal Skin for Repairing Posterior Marginal Perforation.

Objective: To evaluate the graft success rate and hearing gain of endoscopic cartilage myringoplasty with preserving external auditory canal (EAC) skin for posterior marginal perforation. Materials and Methods: We performed a prospective study in 36 patients with posterior marginal perforation who underwent endoscopic cartilage modified inlay technique with preserving EAC skin. Patients were followed up for 12 months. Results: All the 36 patients with unilateral posterior marginal perforation were included in this study. Clinical inosculation of the perichondrium graft and remnant tympanic membrane (TM) occurred at 2 to 3 weeks postoperatively. Simultaneously, neovascularization was initiated at the perichondrium graft. The perichondrium graft had been clinically incorporated to the EAC skin at 2 to 3 weeks postoperatively, which could not be distinguished. At 12 months, residual perforation was seen in inferior margin in one but reperforation was not. The graft success rate was 97.2% (35/36). The mean preoperative air bone gap (ABG) was 29.7 ± 3.8 dB, and the mean postoperative ABG at 12 months was 15.2 ± 3.1 dB; the difference between these values was significant (P < .05; paired-samples t test). The successful surgery rate (postoperative ABG ≤ 20 dB) was 91.7% (33/36). No any intratympanic or EAC cholesteatoma was noted during the follow-up period. Conclusions: Endoscopic cartilage modified inlay technique with preserving EAC skin for repairing posterior marginal perforation is simple and minimally invasive technique, which had shorter operative time, similar graft success rate compared with raising a tympanomeatal flap techniques.

Prımary External Audıtory Canal Cholesteatoma

External auditory canal (EAC) cholesteatoma is characterized by a bony defect in the auditory canal with a cystic structure lined by keratinizing stratified squamous epithelium and retention of keratin debris. Clinically, patients present with chronic dull pain, otorrhea, or conductive hearing loss. Lamellar keratin debris in a bony defect in the case of an intact tympanic membrane is highly suggestive of external ear canal cholesteatoma. It must be differentiated from keratosis obturans. The locally erosive and indolent nature of cholesteatoma in the bony external ear canal may result in complications due to erosion into adjacent structures such as mastoid cells, semicircular canals, fallopian canal, and temporomandibular joint. The treatment options include conservative therapy and surgery. In this case report, we presented a 75-year-old male with a primary left EAC cholesteatoma underlining the diagnostic and therapeutic features of this rare disease.

Diagnosis and treatment of congenital stenosis of external auditory canal with external auditory canal cholesteatoma complicated with exudative effusion in the middle ear and mastoid process

Background The optimal timing for surgery to promote postoperative recovery in children with congenital stenosis of the external auditory canal with external auditory canal cholesteatoma, who are susceptible to exudative inflammation of middle ear and mastoid process, is still uncertain. Objectives To investigate the treatment of congenital stenosis of external auditory canal with external auditory canal cholesteatoma complicated with exudative inflammation. Material and Methods A retrospective analysis of 45 patients with congenital stenosis of external auditory canal with external auditory canal cholesteatoma complicated with mastoiditis. Based on whether effusion had resolved at the time of surgery, the patients were divided into two groups. Pure-tone audiometry tests were performed before and after surgery for both groups. Results The average postoperative duration of dry ear was 36.38 days in Group 1 and 47.90 days in Group 2 (p < 0.05). Among patients who underwent hearing reconstruction, the average air conduction threshold decreased by 15–36 dBHL in Group 1 and by 7–22 dBHL in Group 2 (p < 0.05). Conclusions and significance The postoperative outcomes of dry ear and hearing improvement can be enhanced by performing operation after effusion resolution in cases of congenital external auditory canal stenosis with external auditory canal cholesteatoma exudative inflammation.

Attic reconstruction techniques in cholesteatoma surgery: a comparative analysis of cartilage versus bone pate

Background Cholesteatoma surgery involves canal wall down (CWD) and canal wall up (CWU) mastoidectomy. CWU is associated with higher cholesteatoma recurrence, often linked to attic retraction pockets. Attic reconstruction with cartilage or bone pate lacks comparative evidence. Aims/Objectives To compare the effectiveness of cartilage and bone pate in attic reconstruction during CWU mastoidectomy for cholesteatoma. Material and Methods We conducted a retrospective study at King Abdullah University Hospital (KAUH) in Jordan, analyzing surgeries performed from 2011 to 2021. Patients who underwent CWU mastoidectomy with attic reconstruction using tragal cartilage with perichondrium or bone pate were included. Results Of 48 patients analyzed, 26 had cartilage graft attic reconstruction, and 22 received bone pate. Recurrent cholesteatoma occurred in 19.23% of the cartilage group but none in the bone pate group (p = .001). Ear discharge was observed in 19.23% of the cartilage group and 18.18% of the bone pate group, while tympanic membrane perforations and external auditory canal cholesteatoma were more prevalent in the cartilage group. Conclusions and Significance Our study indicates that bone pate results in significantly lower cholesteatoma recurrence than cartilage grafting in CWU mastoidectomy attic reconstruction. Bone pate offers stability and favorable long-term outcomes for outer attic wall repair.

External auditory canal cholesteatoma: classification and management

Background: External auditory canal cholesteatoma (EACC) is a disease characterized by the accumulation of keratin in the ear canal and erosion of the bony wall. Etiologically, it may be primary or secondary. It presents with ear discharge and pain. Distinction from similar conditions is crucial for appropriate treatment. This study evaluates the EACC. Its purpose is to suggest categories based on disease extent. This study aimed to evaluate the presentation, diagnosis, and treatment of EACC. The goal was to classify EACC based on disease severity and propose treatment approaches. Methods: A retrospective review of medical records for patients diagnosed with EACC over ten years. Clinical data were examined for the presentation, clinical findings, etiology, and treatment. We simplified the approach by dividing the disease into three categories: Category 1, confined to the ear canal; Category 2, eroded the canal wall; Category 3, extended to adjacent structures. Results: 18 patients were included in the study. Ear discharge and otalgia were the most common symptoms. Etiological classification of the disease identified most as secondary EACC. Two cases were assigned to Category 1, six to Category 2, and ten to Category 3. Conclusions: Common symptoms of EACC are ear discharge, pain, and hearing loss. Our study categorizes the condition into three categories based on severity, extension, and treatment strategies. Most cases were assigned to category 3 and extended into adjacent structures.

Risk factors for occurrence and progression of external auditory canal cholesteatoma

ObjectiveExternal auditory canal cholesteatoma (EACC) is characterized by retained squamous debris within the external canal and variable amounts of localized bone destruction. The etiology of primary EACC remains incompletely understood. This study was conducted to analyze the clinical features and backgrounds of patients with primary EACC and to clarify the risk factors for the occurrence and progression of EACC. MethodsSixty-nine ears of 62 patients diagnosed with primary EACC were included in this study (EACC group). Additionally, 74 ears of 60 patients with chronic otitis media (COM) with perforation who underwent tympanoplasty or myringoplasty were included as controls (COM group). We retrospectively investigated the clinical features, life history, and medical history of the patients in both groups. In addition, to investigate the risk factors for progression of EACC, we compared the clinical features and medical history of patients with stage IV (advanced) disease versus stage I + II (mild) disease. ResultsThe inferior wall of the bony canal was the main structure affected in patients with primary EACC of all stages. The following factors were significantly more common in the EACC than COM group: older age, female sex, left-sided disease, osteoporosis, renal dysfunction, anemia, and treatment with bisphosphonates. Among these, the most significant factor associated with EACC was renal dysfunction (odds ratio, 11.4; 95 % confidence interval, 2.32–55.9). The significant factors observed in patients with stage IV disease were younger age, male sex, posterior wall involvement, and otorrhea. Surgical treatment was required for more than half of the patients with stage III and IV EACC. ConclusionPatients with renal dysfunction are at risk of primary EACC. In particular, younger patients and relatively younger elderly patients with posterior wall involvement have a risk of progression to advanced-stage EACC. Canalplasty should be considered in patients with EACC who have these risk factors to prevent progression to advanced-stage disease.

Retracted: Clinical Analysis of 85 Cases of External Auditory Canal Cholesteatoma Surgery under Specialized Endoscopy.

[This retracts the article DOI: 10.1155/2022/9190241.].

Cholesteatoma of the External Auditory Canal Simulating a Petrous Tumor: Case Report

Introduction: “Skin in the wrong place”; cholesteatoma is a non-neoplastic lesion; hardly ever found in the external ear cavity. This affection; secondary or spontaneously, poses diagnostic and therapeutic challenges; one due to its numerous differential diagnosis lead by the absence of pathognomonic symptoms, two due to the lack of surgery strategies and thirdly for its potentially dangerous complications. Case Presentation: The present case elucidates a rare case of spontaneous External Auditory Canal cholesteatoma; (EACC) in 79 years old patient revealed by fetid otorrhea in the right ear, hearing loss, earache and peripheral facial palsy. Radiological imaging showed a massive destruction; of the posterior wall of the external auditory canal, the mastoid cells, tegmen mastoideum and the shell of the third portion of the facial nerve without any morphological or signal abnormalities of the inner ear. A canal wall-down mastoidectomy was performed due to extent of this cholesteatoma, which lead to a full recovery without any follow-up incidents. In light of this finding and to help elaborate the role of clinical examination and radiological imaging, discuss the differential diagnosis and therapeutic surgery management; thus, we report this case. Conclusion: EACC is a rare, potentially dangerous non-neoplastic lesion simulating petrous neoplastic lesion; the diagnosis and the management is multidisciplinary, requiring the coordination of ENT and radiological physician.

A Case of Primary EAC Cholesteatoma Extending into Antrum with Normal Middle Ear

Introduction A cholesteatoma is a three-dimensional sac lined by keratinized squamous epithelium containing desquamated keratinized epithelial cell which secretes enzymes that have the tendency to expand and erode the bony structure underlying it and cause intracranial and extracranial complications. This cystic mass is in an abnormal location such as the middle ear, the petrous apex, or the external auditory canal (EAC). It is mostly found in the middle ear and rarely in the EAC. Here we have reported a rare case of unilateral primary EAC cholesteatoma with mild hearing loss in a middle-aged male. Case Report We have reported a case of a 34-year-old male with complaints of right-sided ear discharge and right-sided decreased hearing for the last 5 to 6 years. On examination, right ear EAC was found to be dry, and a sac was observed in posterior wall extending to mastoid present with clear attic, and intact retracted tympanic membrane that was then followed by radiological evaluation to establish the diagnosis of EAC cholesteatoma. This was surgically treated and ear was cleared of all disease. Patient’s symptoms improved postoperatively. Conclusion Primary EAC cholesteatoma with disease-free middle ear is a rare finding and there is very less definitive literature available on the pathogenesis of the same.

External Auditory Canal Cholesteatoma after Radiation Therapy for Nasopharyngeal Cancer: Case Series and Systematic Review

The authors performed a systematic review, in accordance with the PRISMA guidelines, across multiple databases, including all original studies published until November 2022, focusing on External auditory canal cholesteatoma (EACC) after radiation therapy (RT) for nasopharyngeal cancer (NC). Inclusion criteria were original articles reporting on secondary EACC after RT for NC. Articles were critically appraised to assess level of evidence using the Oxford Center for Evidence-Based Medicine criteria. Overall, 138 papers were identified and after duplicate removal (34 papers) and excluding papers not in English, 93 papers were assessed for eligibility; finally, only five papers were included and summarized with the three cases coming from our institution. These mainly involved the anterior and the inferior part of the EAC. The mean time of diagnosis after RT was the largest series of 6.5 years (with a range from 0.5 to 15.4 years). Patients undergoing RT for NC have 18 times a higher risk of developing EACC compared to the normal population. EACC is probably one of the most underreported side effects, because patients may present variable clinical findings, which could lead to misdiagnosis. Early diagnosis of RT related EACC is advised to enable conservative treatment.

Coexistence of Primary External Auditory Canal Cholesteatoma and Tympanomastoid Paraganglioma: A Diagnostic Dilemma.

Synchronous presentation of cholesteatoma and tympanomastoid paraganglioma is extremely rare. Due to the overlapping clinical features, the clinical diagnosis of coexistence is difficult. Only two cases of tympanomastoid paraganglioma coexisting with middle ear cholesteatoma have been reported in the literature, but simultaneous presentation of primary external auditory canal cholesteatoma and tympanomastoid paraganglioma has not been reported till date. Coexistence of external auditory canal cholesteatoma and paraganglioma is an incidental diagnosis in this current case. The advancement of imaging techniques could help the diagnosis of this very rare clinical coexistence in preoperative assessment.

Taste Alteration in External Auditory Canal Cholesteatoma: Indicator of Impending N VII Affection

Introduction: External auditory canal cholesteatoma (EACC) is a rare disease, with an estimated incidence of approximately 1:1,000 adult and 1.6:1,000 pediatric otologic patients. Systematic studies of chronic ear disease and taste alteration prior to surgery are rare; in fact, there are no such studies for EACCs. Therefore, we describe chorda tympani nerve (CTN) dysfunction and the related clinical consequences in EACC patients. Methods/Study Design: Between 1992 and 2021, we retrospectively analyzed the symptoms, signs, and radiological and intraoperative descriptions of CTN involvement in 73 patients. Liquid taste tests and, since 2009, Taste Strips^TM as well as an olfactory screening test (Smell Diskettes^TM) have been performed for all symptomatic patients and, when feasible, all other EACC patients. Level of Evidence: 4. Results: Ten of 73 patients complained subjectively of dysfunction, and 8 showed abnormal taste test results. Four patients complained of olfactory dysfunction (3 cases with pathological taste tests). Gustatory dysfunction was most frequent in radiogenic EACC cases (n = 4), followed by postoperative EACC (n = 3). Two postoperative patients were asymptomatic despite abnormal test results. Rarely, patients with idiopathic (n = 2) and posttraumatic (n = 1) EACC showed acute taste dysfunction that was confirmed in each with abnormal test results. Discussion/Conclusion: CTN dysfunction often developed asymptomatically in chronic ears, except for idiopathic and posttraumatic EACCs under previous healthy middle ear conditions. Taste disturbance is not a cardinal symptom of EACC, but objective testing suggests that up to one out of 10 EACC patients with advanced disease may experience regional gustatory dysfunction prior to surgery. Especially in context of a new and acute presentation, regional taste dysfunction may alert the clinician of potential progressive EACC invasion and danger to the facial nerve.

手術を施行した外耳道真珠腫12例の検討

External auditory canal cholesteatoma (EACC) is a condition characterized by periostitis of the bone of the external auditory canal. EACC is usually treated conservatively, however, some patients need surgical intervention because of invasion of adjacent structures. We examined the clinical features and surgical procedures used for treatment in 12 patients with EACC who were treated by surgery at our institution. Two patients were classified as stage III and 10 cases as stage IV, accordind to Naims’classification. Eleven cases of patients had primaly EACC, while one was a recurrent case. Six patients underwent canalplasty via a postauricular incision, one patient underwent canalplasty with tympanoplasty, two patients underwent canal wall up tympanoplasty, and three patients underwent canal wall down mastoidectomy. There were no cases of recurrence, although the follow-up period was not sufficiently long in some cases. In order to determine the extent of the cholesteatoma to select the appropriate operative procedure, preoperative CT is crucial. During the operation, it is important to drill pathological bone and smoothen the bony external auditory canal.

A Novel Strategy for Conservative Management of External Auditory Canal Cholesteatoma: Employing 5-Fluorouracil in Ambulatory Care for Select Patients

A Novel Strategy for Conservative Management of External Auditory Canal Cholesteatoma: Employing 5-Fluorouracil in Ambulatory Care for Select Patients

Development of the Sphenoid Sinus in Japanese Children: A Retrospective Longitudinal Study Using Three-Dimensional Computed Tomography.

The sphenoid sinus (SS) is located close to vital structures, such as the pituitary gland, and it has significant clinical relevance. This study aimed to clarify the growth pattern of the SS in Japanese children using three-dimensional computed tomography (CT). Seventy-eight participants with congenital, acquired, or external auditory canal cholesteatoma were recruited and underwent CT more than twice during their treatment. Using the volume-rendered images, the size and volume of the SS were measured. Furthermore, on the scout image, the morphological measurements of the cranial base were determined. The size and volume of the SS increased with age, and peaked at the mean age of 15 years. For males, the volume of the SS was smaller than that of females aged &lt;5 years. The growth rate of the SS was significantly higher in males than in females. The maximum growth rate was detected at the age of 12 years for males and 10 years for females. For females, the increase in the length of the anterior cranial base ceased at approximately 10 years of age and remained constant thereafter. In contrast, for males, the length of the anterior cranial base increased gradually until 15 years of age. Considering the similarity of the periods between the adolescent growth spurt and the maximum growth rate of the SS, changes in the size of the SS may be used as an indicator of the physical growth spurt.

Clinical Analysis of 85 Cases of External Auditory Canal Cholesteatoma Surgery under Specialized Endoscopy.

Objective To investigate the clinical characteristics, surgical experience, and surgical outcomes of external auditory canal cholesteatoma (EACC) surgery under endoscopic otolaryngoscopy. Methods A retrospective analysis of 85 EACC cases admitted to the Department of Otolaryngology, Renji Hospital, Shanghai Jiaotong University School of Medicine, from January 2016 to February 2021 was performed, followed by retrospective analysis of clinical data to explore the feasibility and clinical characteristics of all-oral endoscopic EACC surgery. A total of 85 EACC patients (90 ears) with a mean age of 49.93 ± 14.87 years were included in the study. According to Udayabhanu staging, 43 ears (47.78%) were stage I, 40 ears (44.44%) were stage II, and 7 ears (7.78%) were stage III. All patients underwent transendoscopic surgery. Results 79 ears (87.78%) underwent endoscopic EACC resection alone (+external auditory canal tumor resection/tympanostomy tube insertion), 9 ears (10%) underwent endoscopic EACC resection+tympanostomy+tympanoplasty, 1 ear (1.11%) underwent endoscopic EACC resection+tympanoplasty, and 2 ears (2.22%) underwent EACC resection+otolaryngotomy+tympanoplasty+auditory chain reconstruction endoscopically. Of these, 7 ears (7.78%) underwent auricular cartilage-chondroplasty and 2 ears (2.22%) underwent auricular cartilage membrane repair. All patients were reviewed at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year postoperatively. One patient with stage II external auditory atresia had a recurrence after 6 months and underwent endoscopic ear surgery (ESS) again. One patient with stage 2 atresia recurred after 1 year and again underwent endoscopic ear surgery. The rest of the patients recovered well after the surgery, and the grafts healed well. Conclusion EACC surgery through the external ear canal under a dedicated endoscope is a safe, reliable, and effective method. Patients with stage I and II external auditory canal cholesteatoma surgery under endoscopy have a rapid postoperative recovery with significant hearing improvement, and stage IIIA patients can also achieve good results under strict evaluation of indications.

Clinical features, diagnosis and treatment for patients presenting with granulation tissue of the external auditory canal

Objective:To explore the clinical characteristics and diagnosis and treatment in the patients presenting with granulation tissue of the external auditory canal. Methods:The data of 71 postoperative patients presenting with granulation tissue of the external auditory canal in the Department of Otolaryngology, the First Affiliated Hospital of the Air Force Military Medical University from January 2015 to June 2020 were analyzed retrospectively, including the chief complaint, physical examination, auxiliary examination and preoperative imaging, biopsy was performed when necessary to confirm the diagnosis. Among the 71 patients, 30 cases were diagnosed as chronic otitis media, 19 cases were external auditory canal cholesteatoma, 5 cases were external auditory canal carcinoma, 6 cases were paraganglioma, 1 case was granulomatous hemangioma, 1 case was first branchial cleft fistula, 4 cases were granuloma of the external auditory canal, 4 cases were hemangioma of the external auditory canal, and 1 case was foreign body of the external auditory canal. Individualized treatment plans are made according to the characteristics and extent of the lesions. Results:Postoperative follow-up was 12 to 74 months, with an average of （44±18.1） months. Seventy patients（98.6%） had no complications such as sensorineural deafness, external auditory stenosis or peripheral facial paralysis after surgery, and one patient with paraganglioma had postoperative neurological function grade Ⅱ, and was treated with nutritional nerves, and the postoperative neural function recovered to grade Ⅰ after 3 months. Conclusion:The patients presenting with granulation tissue of the external auditory canal can be diagnosed as various diseases. It is necessary to analyze the patient's medical history in detail, confirm the diagnosis in combination with imaging examination, and formulate an individualized treatment plan to reduce misdiagnosis and missed diagnosis.

Variation and protection of the chorda tympani nerve in endoscopic ear surgery

ObjectiveTo observe and summarize variations of the chorda tympani nerve to effectively protect it during surgery.MethodsSurgical videos of patients undergoing endoscopic ear surgery in the past 3 years were retrospectively observed to identify chorda tympani nerve variations.ResultsIn total, 237 cases were reviewed. The tympanic sulcus or annulus was the boundary between the posterior wall of the external auditory canal and chordal eminence (CE). The chorda tympani nerve was divided into three types: type I, the periannular segment was located medial to the CE and covered by the bony eminence (32.5%); type II, the periannular segment was located inferior to the CE, and the nerve did or did not contact the bony edge of the CE (62.0%); and type III, the periannular segment was located lateral to the CE and medial to the tympanic annulus, and the iter chorda posterius was located in the tympanic sulcus (5.5%). The rate of injury to the chorda tympani nerve was 2.5% of 237 cases. The location of the iter chorda posterius on preoperative computed tomography was highly reliable for prediction of type I and III nerves. Secondary exposure of the posterior canaliculus might occur in patients with external auditory canal cholesteatoma, who were specifically included in this study.ConclusionCE‐based classification of the chorda tympani nerve can concisely describe variations of the chorda tympani nerve and provide guidance for neuroprotection during endoscopic ear surgery. Patients with external auditory canal cholesteatoma may have secondary exposure of the posterior canaliculus.Level of EvidenceNA.

Clinical analysis and surgical treatment of congenital external auditory canal stenosis complicated with external auditory canal cholesteatoma

Objective:To investigate the clinical features, diagnosis, and treatment experience of congenital stenosis of an external auditory canal with external auditory canal cholesteatoma. Methods:The clinical data of 152 patients（153 ears） with congenital external auditory canal stenosis complicated with external auditory canal cholesteatoma treated in the Department of Otorhinolaryngology Head and Neck Surgery of Beijing Tongren Hospital affiliated to Capital Medical University from January 2009 to December 2019 were analyzed retrospectively, including the age of onset, clinical manifestations, signs, audiology, high-resolution computed tomography（HRCT） of the temporal bone, mode of operation and so on. According to the preoperative imaging findings, intraoperative findings,and pathological results, 152 patients with congenital external auditory canal stenosis with external auditory canal cholesteatoma were treated with canaloplasty and tympanoplasty while clearing the cholesteatoma. Results:All patients were followed up for 2-2.5 years, there was no recurrence of cholesteatoma, and the reconstructed external auditory canal was spacious. The hearing levels of 108 ears who underwent hearing reconstruction were significantly improved, and the average hearing threshold was reduced by 20-35 dB. Conclusion:The stenosis of the external auditory meatus is easy to be complicated with cholesteatoma of the external auditory canal,and the occurrence of cholesteatoma of the external auditory canal is directly related to the diameter of the external auditory canal meatus.But the time of occurrence of the cholesteatoma is not directly related to the diameter of the external auditory canal. Severe congenital stenosis of the external auditory canal with auricle deformity is easy to be missed and misdiagnosed due to retroauricular redness, swelling, and ulceration. For this kind of patient, cholesteatoma should be treated first, and then plastic surgery such as auricle reconstruction should be performed. Retroauricular incisions should be avoided to create conditions for auricle reconstruction in the future.

Diagnosis of pediatric external auditory canal cholesteatoma - A rare case report

Pediatric external auditory canal cholesteatoma (EACC) is a rare and progressive disease with potential erosion and high destruction of neighboring structures. We report a case of right external auditory canal cholesteatoma in a three-year-old girl. She was admitted to Vinmec Times City Hospital with episodes of otorrhea and otalgia in the right ear for about one year and was diagnosed with EACC. Laparoscopic surgical resection was performed for treatment. After operation, the patient is being observed until 9 months without any recurrence.