External Auditory Canal Cholesteatoma Research Articles

Surgical management of external auditory canal lesions

Lesions arising in the external auditory canal that require surgical excision are uncommon. They are associated with a range of pathologies, including bony abnormalities, infections, benign and malignant neoplasms, and epithelial disorders. This paper describes a 10-year personal case series of external auditory canal lesions with chart, imaging and histopathology review. In total, 48 lesions required surgical management, consisting of: 13 bony lesions; 14 infective lesions; 14 neoplasms with 11 histological types (including ceruminous adenoma and the extremely rare cavernous haemangioma); 3 epithelial abnormalities; and 4 other benign lesions. The surgical management is described. This study emphasises the diagnostic differences between exostoses and osteomas, and between external auditory canal cholesteatoma and keratosis obturans. It also discusses the management of aural polyps, and highlights the need to excise external auditory canal masses for histology in order to guide subsequent treatment.

A Case of Congenital Cholesteatoma of the External Auditory Canal Removed Using an Endoscope

Congenital cholesteatoma of the external auditory canal is a rare disease. We report a 3-year-old male child with congenital cholesteatoma of the left external auditory canal. A white mass existed at 10-12 o’clock of the canal. In computed tomography (CT) of the temporal bone, a low-density lesion was located in contact with the tympanic membrane, but not clearly invaded the middle ear cavity. Treatment consisted of removal using an endoscope. At the 7-month postoperative follow-up there was no evidence of any relapses. We discuss herein the indication of surgery for congenital cholesteatoma of the external auditory canal.

A Comparison of Patterns of Disease Extension in Keratosis Obturans and External Auditory Canal Cholesteatoma

To investigate the different pathways of progression to the middle ear in keratosis obturans (KO) and external auditory canal cholesteatoma (EACC). Retrospective case review. Referral hospital otolaryngology department. Patients with KO or EACC and middle ear disease who underwent surgical management were included. Four ears of 4 patients (mean age, 41.25 yr) were the KO group, and 5 ears of 4 patients (mean age, 49.5 yr) were the EACC group. Intraoperative findings of the middle ear cavity were investigated in KO and EACC groups. In the KO group, 3 patients had a perforated tympanic membrane and cholesteatoma in the tympanic cavity. The other patient had preoperative right facial palsy. Removal of the keratin plug revealed an adherent tympanic membrane. In intraoperative findings, the tympanic segment of the fallopian canal was found to be eroded because of inflammation. No case initially progressed to the mastoid cavity. Four patients had external auditory canal cholesteatoma with middle ear disease. In EACC group, all patients had initial progression to the mastoid cavity. KO tends to progress initially to the tympanic cavity via a diseased tympanic membrane. EACC tends to progress to the mastoid cavity via destruction of the posterior bony canal. This is the first report to investigate differences in pathway of progression to the middle ear cavity in these 2 diseases.

Primary external auditory canal cholesteatoma presenting as cerebellar abscess

External auditory canal cholesteatoma (EACC) is an uncommon disease and its pathogenesis remains unclear. Clinically, patients usually present with symptoms like chronic dull pain and otorrhea, but many patients can be astonishingly silent or even asymptomatic. The intracranial complication with extensive mastoid cavity from primary EACC is extremely rare. Early diagnosis is imperative to facilitate best possible intervention and to relieve patient symptoms and to prevent further complications. We present the first report in the English literature of a case of primary EACC presenting as cerebellar abscess. We experienced a rare case of a 55-year-old female patient admitted in our hospital with cerebellar abscess complicated by a cholesteatoma in the external auditory canal. The patient was first managed conservatively with systemic antibiotics by neurosurgeon, and then the disease was removed successfully by canal wall down mastoidectomy and no recurrence had occurred in the first 4 months post-operatively.

The co-existence of an osteoma with cholesteatoma in the external auditory canal: Report of an extremely rare case

Diș kulak yolu osteomlari yavaș buyuyen, genellikle belirti vermeyen, etiyolojisi bilinmeyen ve oldukca nadir gorulen neoplazilerdir. Kolesteatomlar neredeyse her zaman orta kulakta ve mastoidde gorulseler de, nadir durumlarda diș kulak yolunda da gorulebilirler.Diș kulak yolunda osteom ve kolesteatomun beraber gorulmesi cok nadirdir ve literaturde bildirilmiș birkac olgu vardir. Biz bu yazida diș kulak yolunda osteoma sekonder gelișen kolesteatomu olan 43 yașinda bir erkek hasta olgusunu sunduk.

Precise Reconstruction of Auditory Canal Defect in External Auditory Canal Cholestestoma with Bonewax Template

Precise reconstruction of external auditory canal (EAC) defect is important for the prevention of retraction pocket and recurrent cholesteatoma. This report describes a new technique for the reconstruction of EAC defect by using bonewax template and the cortical bone. Canal defect reconstruction was performed successfully after the removal of EAC cholesteatoma. There has been no recurrence, and the outcome was excellent. This method avoids a sharp edge in EAC, which deters good epithelialization and promotes granulation tissue and enables the avoidance of subsequent retraction and formation of recurrent cholesteatoma. We recommend the use of bonewax template for the reconstruction of canal defects as a simple and precise method.

The misdiagnosis of external auditory canal carcinoma

External auditory canal (EAC) carcinomas are frequently misdiagnosed. The aim of this study was to conduct a review of misdiagnosed cases and analyze the factors involved. This study was a retrospective assessment. Eighteen of 44 EAC carcinoma cases seen at the Eye and ENT Hospital were misdiagnosed. All medical records were retrospectively analyzed for the age, sex, presenting symptoms, type of misdiagnosis, computed tomographic (CT) or magnetic resonance imaging (MRI) findings, stage of the cancer, surgical approach, histopathological examination, adjunctive therapy (postoperative radiotherapy) and outcomes of treatment. Six cases were misdiagnosed as otitis media, five cases were misdiagnosed as otitis externa, and two cases were misdiagnosed as external auditory canal cholesteatomas. Other misdiagnoses were stenosis of the EAC, ear neuralgia, furuncle of the EAC, benign neoplasm of the EAC and pre-auricular fistula. Our analyses suggest that a biopsy should be conducted to obtain a histopathological diagnosis if an EAC carcinoma is suspected, in case otitis media or otitis externa does not respond to routine anti-bacterials. Head and neck MRI should be used to explore the involvement of soft tissues. Patients with bloody ear discharge and otalgia, particularly with temporal bone erosion seen in a CT scan, are highly likely to have a malignant carcinoma of the temporal bone.

Surgical treatment of monostotic fibrous dysplasia of the temporal bone: a retrospective analysis

ObjectiveThe aim of this study was to analyze the therapeutic effect of external auditory canal stenosis caused by monostotic fibrous dysplasia of the temporal bone by operation. MethodsSeven patients who were finally diagnosed as having monostotic fibrous dysplasia of the temporal bone by temporal bone high-resolution computed tomography (CT) and pathological diagnosis after operation underwent surgical reconstruction of the external auditory canal. The follow-up lasted 2 to 6 years, and it included pure-tone audiometry otoendoscopy, and high-resolution CT of the temporal bone. The hearing recovery and formed external auditory meatus results were retrospectively analyzed. The data were obtained from the Department of Otolaryngology in Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, from April 2003 to September 2008. ResultsWe found 4 ears with combined external auditory canal cholesteatoma intraoperative. The mean pure-tone audiometries (0.5, 1, 2 kHz) and the air-bone gaps for all patients improved after 6 months postoperation. The result was statistically significant. The average air-bone gap was improved, and the external auditory canal restenosis appeared in 1 patient after 4 years. Reconstruction of the external auditory canal was performed in this patient, and no restenosis was found in subsequent 2-year follow-up. All cases were reviewed with CT and otoendoscopy to observe the results and lesion extent, and we found that the lesion was basically stable without significant progress to the periphery major structure. ConclusionThe monostotic fibrous dysplasia of the temporal bone and its causative external auditory meatus stenosis must be treated as early as possible to recover its patency of external auditory canal to prevent complicated cholesteatoma. Satisfaction results can be obtained from surgical reconstruction of the external auditory canal. We can excise the pathological change of the external auditory canal simply to restore auditory function and eliminate clinical symptoms such as earache, ear muffled sense, and so on. Because the development of lesions was slow during the follow-up, the complete resection of all lesions was not necessary, the external auditory canal restenosis may be operated again, and the prognosis was optimistic.

Middle ear foreign body causing cholesteatoma and external auditory canal granuloma: a case report

ObjectivePatients with unilateral ear discharge and hearing loss often have external or middle ear diseases. We present a 55–year–old man who suffered from persistent ear discharge and hearing loss in the left ear. Local findings showed that his left ear canal was filled with a large amount of granulation tissue, with purulent, foul–smelling discharge. Computed tomography indicated left middle ear cholesteatoma and mass shadow in the left external auditory canal. Modified radical mastoidectomy was performed. A piece of white plastic stick was found in the middle ear during the operation. Foreign body–induced cholesteatoma and external auditory canal granuloma in adults are very rare. We present this rare case so that these conditions can be better recognized and understood.

Complication of dilute vinegar therapy for external auditory canal cholesteatoma

We read with great interest the recent article by Chang et al. [1] which advocated the use of repeat irrigation with dilute vinegar in conjunction with regular microscopic local cleansing to manage spontaneous external auditory canal (EAC) cholesteatoma. In their series of 16 patients, they declared no complications resulting from this treatment regimen. However, we wish to report that when we trialled the very same regimen on one of our patients, our patient suffered a perforated tympanic membrane with subsequent worsened pain and otorrhoea, just 7 days after starting this treatment. Her external canal cholesteatoma was classified as grade I according to Chang’s suggested temporal bone CT staging, i.e., with flattening of the bony external canal. She had surgical debridement and reconstruction of the EAC 6 months previously and was keen to explore another treatment option apart from repeat surgical intervention. She followed the self-cleansing instructions exactly as described in Chang’s paper, using a 10-ml syringe to gently irrigate her ear canal with dilute vinegar, 40 ml in total volume daily, aiming towards the posterior canal wall. When the tympanic membrane perforation was detected at her next clinic visit, she was instructed to stop the vinegar washouts and to commence a course of quinolone ear drops, after which her otorrhoea improved. She is currently still attending our clinic regularly for repeat microsuctioning of her canal cholesteatoma. If her perforated tympanic membrane fails to heal (and it has not done so thus far after 5 weeks), then performing a tympanoplasty would be the next obvious option.Cadaveric studies have found an association of ear irrigation with rupture of atrophic tympanic membranes with the lowest tensile strength but not of normal tympanic membranes [2]. Our patient’s tympanic membrane was essentially normal before the perforation event and her cholesteatoma is solely confined to the EAC, as confirmed on computed tomography scanning on two separate occasions. We would like to politely enquire if the authors have experienced similar complications since publication of their paper or if they have any further insights into the vinegar regimen to share with us.

A Case of External Auditory Canal Cholesteatoma Caused by Osteoradionecrosis of the Temporal Bone after Irradiation Therapy for a Brain Tumor

A Case of External Auditory Canal Cholesteatoma Caused by Osteoradionecrosis of the Temporal Bone after Irradiation Therapy for a Brain Tumor

External Auditory Canal Cholesteatoma and Keratosis Obturans: The role of Imaging in Preventing Facial Nerve Injury

We conducted a retrospective study to compare the clinical characteristics of external auditory canal cholesteatoma (EACC) with those of a similar entity, keratosis obturans (KO). We also sought to identify those aspects of each disease that may lead to complications. We identified 6 patients in each group. Imaging studies were reviewed for evidence of bony erosion and the proximity of disease to vital structures. All 6 patients in the EACC group had their diagnosis confirmed by computed tomography (CT), which demonstrated widening of the bony external auditory canal; 4 of these patients had critical erosion of bone adjacent to the facial nerve. Of the 6 patients with KO, only 2 had undergone CT, and neither exhibited any significant bony erosion or expansion; 1 of them developed osteomyelitis of the temporal bone and adjacent temporomandibular joint. Another patient manifested KO as part of a dermatophytid reaction. The essential component of treatment in all cases of EACC was microscopic debridement of the ear canal. We conclude that EACC may produce significant erosion of bone with exposure of vital structures, including the facial nerve. Because of the clinical similarity of EACC to KO, misdiagnosis is possible. Temporal bone imaging should be obtained prior to attempts at debridement of suspected EACC. Increased awareness of these uncommon conditions is warranted to prompt appropriate investigation and prevent iatrogenic complications such as facial nerve injury.

Dilute vinegar therapy for the management of spontaneous external auditory canal cholesteatoma

The purpose of this study is to evaluate the efficiency of conservative dilute vinegar therapy in the management of spontaneous external auditory canal cholesteatoma (EACC). From 2000 to 2007, 19 patients presented to our clinic with spontaneous EACC. EACC was divided into four grades based on the temporal bone computed tomography: grade I with flattening of bony external canal, grade II with partial destruction of inferior bony canal, grade III with total destruction of inferior bony canal and grade IV with bony destruction into the middle ear and mastoid cavity. Clinical findings and treatment results were recorded. Microscopic local cleansing and dilute vinegar therapy was conducted in the ears with grades I, II and III. Combined mastoid surgery and dilute vinegar therapy was conducted in four ears with stage IV. There were no recurrences after average of 31 months follow-up. Spontaneous EACC can be effectively controlled with dilute vinegar therapy after microscopic local cleansing. However, surgery must be considered in the cases which have involved the mastoid and middle ear. Dilute vinegar therapy in combination with microscopic local cleansing was effective in the management of spontaneous EACC. Dilute vinegar therapy is an easy, cost-effective, and home-based cleansing method to prevent EACC and promotes healing. However, long-term follow-up may reveal frequent recurrence of cholesteatoma debris and involvement of middle ear or mastoid cavity, and then meticulous debridement with skin graft or surgical intervention should be considered.

External auditory canal cholesteatoma in microtia with aural atresia-A case report

External auditory canal cholesteatoma in microtia with aural atresia-A case report

Autotymapanomastoidectomy in a Case of Cholesteatoma with Foreign Body

A unique case of foreign body of the external auditory canal (EAC) in a 16year old boy with normal intelligence is presented. The foreign body caused the cholesteatoma to flourish behind the obstruction resulting in complete destruction of middle ear cleft and external auditory canal to form a single large cavity. The diagnosis of foreign body remained elusive till the last and could be proved only after biochemical analysis. We also discuss the Keratosis obturans, cholesteatoma of external auditory canal and the process of calcification in cholesteatoma ear, which was thought to represent the foreign body in this case.

A Case of External Auditory Canal Cholesteatoma Involving the Zygomatic Arch Root

External auditory canal cholesteatoma involving the zygomatic arch root is rare. A 15-year-old youth with aural stenosis had a history of right temporomandibular joint trauma and right external auditory canal cholesteatoma surgery. Computed tomography (CT) showed soft tissue density from the attic to the root of the zygomatic arch. The lesion showed high signal intensity in diffusion-weighted magnetic resonance imaging (MRI) and the case was diagnosed as external auditory canal cholesteatoma, subsequently resected combining retro auricular and pre auricular approaches.

Therapeutic Approaches to Complicated Cholesteatoma of the External Auditory Canal: A Case of Associated Facial Paresis

Spontaneous cholesteatoma of the external auditory canal (EAC) is an uncommon condition that is difficult to diagnose. In a patient with such a possibility, serious clinical investigation along with radiologic and histologic exploration should be performed early on because a delay in treatment can lead to severe complications. Given the rarity of EAC cholesteatoma, no therapeutic consensus has emerged. The type of management depends on the extensiveness of invasion and bone erosion and the status of the neighboring structures. The primary therapeutic objectives are to eradicate the cholesteatoma and then to fill in the residual cavity, which in our opinion can be best accomplished with a muscle flap and EAC reconstruction. Postoperative follow-up should be carried out to look for infections, stenosis, and recurrence. We report a new case of spontaneous EAC cholesteatoma, and we review its diagnostic and therapeutic challenges.

Congenital primary cholesteatoma of external auditory canal

A 2-year-old female child is reported with congenital cholesteatoma of the right external auditory canal. We describe the clinical features, computed tomography finding and surgical treatment. Congenital cholesteatomas can occur within the temporal bone. Congenital cholesteatoma of the external auditory canal is rare. Generally, it appears in the canal floor. Treatment consists of the resolution of granulation and removal of debris.

Development of canal cholesteatoma in a patient with prenatal isotretinoin exposure

Purpose To describe the clinical and radiologic findings in a case of isotretinoin embryopathy-like syndrome and discuss management of hearing loss, congenital external auditory canal (EAC) stenosis, and EAC cholesteatoma. Methods Review of medical, audiological, and radiological records. Results An 8 year old female presented with bilateral moderate conductive hearing loss, bilateral microtia, left EAC stenosis, and right EAC atresia, secondary to prenatal isotretinoin exposure. Comorbidities included developmental delay, ventricular septal defect, hypotonia, and retinal maldevelopment. The left EAC was sharply upsloping with a 2 mm-diameter meatus. Computed tomography (CT) scan of the temporal bone demonstrated normal middle and inner ears bilaterally; serial CT scans over 6 years demonstrated progressive development of left canal cholesteatoma. Implantation of a right BAHA system was performed, followed by left canalplasty and excision of cholesteatoma with facial nerve monitoring. An endaural incision was utilized to avoid compromising future microtia repair. Postoperative left-sided hearing improved to mild low-frequency conductive hearing loss rising to normal at 2000 Hz and above. Conclusions Despite extensive precautions for its use, isotretinoin remains a cause of major birth defects, including sensorineural, conductive or mixed hearing loss. Congenital EAC stenosis is much less common than congenital atresia or acquired stenosis; optimal surgical approaches vary depending on hearing status and facial nerve anatomy. Close monitoring for development of canal cholesteatoma is necessary.

Conservative management of advanced external auditory canal cholesteatoma

Objective To investigate the spectrum of disease presentation and clinical management of primary external auditory canal cholesteatoma (EACC). Study Design Case series with chart review. Setting Specialty teaching hospital. Subjects and Methods Ten cases of primary EACC were identified in nine patients treated over 14 years (1995-2009). Cases were reviewed with regard to demographics, presentation, physical examination, CT findings, and clinical management. Results The most common symptoms were otalgia and hearing loss, followed by otorrhea and tinnitus. Erosion was present in the mastoid air cells in seven patients, middle ear in six, temporomandibular joint in two, otic capsule in two, and fallopian canal in one patient. Eight of nine patients were managed with serial debridement. Conclusions EACC is associated with adjacent bony erosion, most often involving the inferior EAC. Despite the potentially destructive nature of these lesions, most cases can be successfully managed with serial debridement.