External Auditory Canal Stenosis Research Articles

A Case of Multiple Osteomas in the External Auditory Canal

Osteoma is a benign neoplasm that can occur and extend beyond the nearest region in the external auditory canal (EAC); however, a multiple growth of the tumor in the ipsilateral ear has never been reported. A 41-year-old male patient having a past history of uncertain chronic otitis media complained of recent otalgia and progressive hearing loss in the same ear. Physical examination showed that two hard masses arising from both anterior and posterior aspect of the right EAC were contacting each other and obstructing most of the lumen. High resolution computed tomography scan revealed not only two growing exophytic bone lesions causing EAC stenosis but also inflammation of the middle ear and sclerotic mastoid cavity. We performed excision and middle ear surgery at the same time. Both specimens were pathologically confirmed as osteomas, so we report this unusual case with a review of literature. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:44-6 Key WordsZZOsteoma·External auditory canal·Multiple.

Congenital external auditory canal stenosis and partial atretic plate

Objectives To report outcomes of surgery for severe congenital external auditory canal (EAC) stenosis with or without partial atretic plate (PAP). Design Retrospective review. Subjects Thirteen patients (18 ears) had surgery for severe EAC stenosis with ( n = 10, 56%) or without PAP ( n = 8, 44%). Indications included severe stenosis with hearing loss, cerumen impactions, and/or canal cholesteatoma. Mean age = 7.8 years (range 0.4–19.9 years). Mean follow up = 5.2 years (range 0.4–10.0 years). Setting Tertiary care children's hospital. Interventions Nineteen endaural canaloplasties were performed in 17 ears (2 revisions). There was one post-auricular approach. Fifteen tympanoplasties were performed in 13 ears (2 revisions). PAP was reconstructed with drilling to enlarge the bony annulus and fascia grafting to enlarge the tympanic membrane in 10 (56%) ears. Outcome measures Patency of EACs; otologic findings; pure tone averages (PTA); complications. Results All (100%) EACs had improved patency (≥4 mm). Findings included canal cholesteatoma (2/18, 11%), ossicular fixation (4/18, 22%), stapes abnormality (2/18, 11%), and incudostapedial discontinuity from cholesteatoma (1/18, 6%). Mean preoperative PTA = 38.7 dB HL (range 60–20 dB HL). Mean post-operative PTA = 23.6 dB HL (range 50–6.7 dB HL). Audiologic results were significantly better for cases without PAP ( p < .01) and without ossicular fixation ( p < .01). There were seven minor and no major complications. Conclusions Endaural canaloplasty is safe and effective for providing patent EACs and hearing improvement for severe congenital EAC stenosis. However, since hearing outcomes were worse for cases with PAP and ossicular fixation, alternatives such as hearing aids or BAHA ® may be considered.

Expansile Bone Cyst and Cholesteatoma of the Temporal Bone

To identify primary bony cysts of the temporal bone. A single case of a woman presenting with unilateral bulging of the temporoparietal cranium, progressive stenosis of the external auditory canal, and maximal conductive hearing loss. Plain x-rays, magnetic resonance imaging, contrast-enhanced computed tomography, audiogram, and modified radical mastoidectomy. Radiologic and histopathologic diagnosis of a primary bone cyst of the temporal bone obstructing the external auditory canal with a retained cholesteatoma of the middle ear. Identification of an inflammatory bony cyst of the temporal bone with a retained cholesteatoma of the middle ear resulting in stenosis of the external auditory canal and maximal conductive hearing loss. Primary bone cyst of the temporal bone can lead to external auditory canal stenosis, middle ear cholesteatoma, and conductive hearing loss.

Availability of Spectral Gradient Acoustic Reflectometry

Background and Objectives Spectral gradient acoustic reflectometry (SGAR) determines the probability of middle ear fluid by measuring the response of the tympanic membrane to a sound. To assess the sensitivity and specificity of SGAR for the diagnosis of otitis media with effusion (OME) in the Korean population, we compared accurate diagnostic rates of OME obtained from SGAR and tympanometry. Pneumatic otoscope was used for diagnostic standard of OME. Subjects and Method SGAR and tympanometry were performed on 488 ears from May 27th, 2008 to July 30th, 2008. Exclusion criteria were the presence of tympanic membrane perforation, and/or pressure equalization tubes, noncompliance, otorrhea, external auditory canal stenosis and signs of acute inflammation such as fever or otalgia. In all cases, pneumatic otoscopic examination was conducted and diagnostic accurate rates of OME were calculated in SGAR and tympanogram. Results Using spectral gradients of 3 or higher as breakpoints for indicating OME, in the case of pediatrics under 2 years old, with the sensitivity of 58.3%, specificity of 94.7%, positive predictive value (PPV) of 77.8% and negative predictive value (NPV) of 87.8%. In the case of the pediatrics between 2 and 12 years old, it showed the sensitivity of 67.2%, specificity of 90.3%, PPV of 74.5% and NPV of 86.8%. In the case of the pediatrics over 12 years old, they showed sensitivity of 87.3%, specificity of 88.8%, PPV of 67.6% and NPV of 96.3%. Conclusion SGAR has the higher tendency of specificity and NPV, and will be a useful screeningtest with good portability and economical efficiency.

Two Cases of Meatoplasty and Otoplasty Simultaneously in Patients with Auricular Deformities and External Auricular Canal Stenosis

As the auricle is a very complex structure covered with thin, sensitive skin, the best reconstruction requires a great deal of skill and the use of diverse approaches. Otolaryngologists should give greater consideration to otoplasty because patients do not want their self-confidence impaired by auricular deformities. When treating external auditory canal (EAC) cholesteatoma caused by EAC stenosis, the blood circulation may be deleteriously affected if the retroauricular incision is made first, and thus the otoplasty must be first carried out. We report two cases of otoplasty performed simultaneously with meatoplasty without the aid of plastic surgeons. The first case involved a 33-year-old woman with cholesteatoma due to congenital auricular atresia and microtia. The second case was a 64-year-old man with traumatic auricular amputation and EAC stenosis due to scar contracture. Simultaneous otoplasty and meatoplasty should be of benefit to patients because it reduces the number of operations and has a high success rate. (Korean J Otorhinolaryngol-Head Neck Surg 2009;52:386-90)

Auricular Ossification Resulting in External Auditory Canal Stenosis

We report the case of a 49-year-old man who presented with left aural fullness, hearing loss, and a stenotic left external auditory meatus. Physical examination and computed tomography revealed the presence of an idiopathic ossification of the cartilaginous auricle and external auditory canal. The patient was successfully treated with meatoplasty. Pathologic examination of the removed specimen revealed osseous metaplasia.

The Use of a Custom Earmold to Prevent Recurrent External Auditory Canal Stenosis

The treatment of external auditory canal (EAC) stenoses often requires the prolonged use of a stent or splint. Traditional stents often occlude the EAC, resulting in a temporary conductive hearing loss. This case report describes a custom canal earmold with a large bore used as a stent in a patient with EAC stenosis. The customized earmold stent successfully prevented restenosis, while the large bore provided ventilation and improved hearing subjectively during the stenting phase.

The formation of sinus in congenital stenosis of external auditory canal with cholesteatoma

Conclusions. In congenital stenosis of the external auditory canal (CSEAC) with cholesteatoma, the bony wall of the external auditory canal (EAC) is most commonly involved. This involvement will lead to bone erosion of the EAC and may subsequently lead to the formation of postaural or cervical sinuses. High-resolution computed tomography (HRCT) of temporal bone can show characteristic signs of soft tissue mass in EAC, with adjacent bone erosion. Objective. To investigate the clinical features, differential diagnosis and management of CSEAC with cholesteatoma. Patients and methods. The clinical information for 10 cases of CSEAC with cholesteatoma was retrospectively reviewed. Results. The patients’ ages ranged from 4.75 to 22 years (average 12 years). The diameter of EACs was < 2 mm. All 10 ears had a history of postaural fistulae or sinuses. Bone erosion of EAC was distinctly shown in HRCT of all cases, as well as soft tissue masses, which led to enlargement of the bony canals. All patients underwent canaloplasty; eight ears received hearing reconstructions at the same time. Cholesteatoma in EACs was confirmed during the operations, accompanied by compression and destruction of the post-superior and/or inferior bony wall. Postoperative pathologic examinations proved the diagnosis of cholesteatoma, and excluded any tissue of bronchial cleft cyst or fistula. After a follow-up of 1–3 years, no recurrent cholesteatoma was found in any of the 10 cases. All reconstructed EACs were clean and smooth. The hearing levels in the eight ears that received hearing reconstructions increased 20–35 dBHL.

Temporal Bone CT Findings in Cornelia de Lange Syndrome

Cornelia de Lange syndrome is a rare developmental malformation syndrome with a high prevalence of hearing impairment. The purposes of this study were to describe the characteristic temporal bone CT findings in patients with Cornelia de Lange syndrome and to correlate audiometric data with radiologic findings in these patients. Ten children (6 girls and 4 boys; mean age, 42.0 months) who were clinically diagnosed with Cornelia de Lange syndrome (classic, n = 5; mild form, n = 5) were enrolled. Temporal bone CT was prospectively performed, and 32 aspects of each temporal bone CT were analyzed, 21 by direct measurement and 11 by visual inspection. Twenty age-matched children (n = 20 ears) with normal temporal bone CT scans served as a control group. Audiologic tests were also performed on all patients. Characteristic temporal bone CT findings of Cornelia de Lange syndrome were external auditory canal stenosis, soft-tissue opacification of the hypoplastic tympanomastoid cavity, dysmorphic ossicle, hypoplastic cochlea, and dysplastic vestibule, all of which were more prevalent in patients with the classic form of the disease than in those with the mild form. Children who had more severe structural abnormalities on temporal bone CT had worse hearing levels compared with those without structural abnormalities. Temporal bone CT scans in Cornelia de Lange syndrome could document combined structural abnormalities of the external, middle, and inner ear, which were one of the characteristic clinical manifestations; CT abnormalities were well correlated with the audiometric data.

Goldenhar syndrome with external auditory canal stenosis complicated by canal cholesteatoma and first branchial cleft cyst

Goldenhar syndrome with external auditory canal stenosis complicated by canal cholesteatoma and first branchial cleft cyst

Goldenhar syndrome with external auditory canal stenosis complicated by canal cholesteatoma and first branchial cleft cyst

This report features a case of Goldenhar syndrome with congenital left facial nerve paralysis, microtia and external auditory canal stenosis complicated by an external auditory canal cholesteatoma and first branchial cleft cyst. The workup and surgical management of this rare constellation of defects is detailed. The features of this case are instructive as they provide insight into abnormal ear development. Otolaryngologists should retain a high index of suspicion for the presence of congenital cholesteatoma, branchial cleft anomalies and facial nerve abnormalities when evaluating patients with Goldenhar syndrome.

先天性外耳道狭窄症は危険な病態である‐診断と対応の仕方‐

Congenital external auditory canal stenosis (CAS) is usually considered one of the slight malformations related to congenital external auditory canal atresia (CAA). However, the clinical symptoms caused by the slight malformation may not be mild. Destructive external ear canal cholesteatoma commonly occurs in CAS, but is infreguent in CAA. For several reasons CAS tends to receive an inappropriately low estimate of risk compared to that for CAA. The other malformations accompanying CAS and CAA such as microtia confound the decision regarding future treatment for doctors as well as for the patients themselves. A consensus regarding the clinical entity of CAS is required among doctors not only in otorhinolaryngology but also in relevant fields such as pediatrics and plastic surgery. These two malformations, the pathological conditions and clinical treatment of CAS and CAA should be considered separately.

Acquired external auditory canal stenosis: assessment and management

Although uncommon, acquired external auditory canal stenosis is an entity that is encountered by many otolaryngologists. This paper reviews the causes, pathogenesis, assessment, and management options for external auditory canal stenosis. Initially, acquired external auditory canal stenosis was described as resulting from a number of different causes. Since then, histology and imaging studies of this disease have shown that a common cascade of inflammatory changes resulting from these different causes is the primary pathogenesis leading to medial canal fibrosis. Once there is complete obstruction of the external auditory canal, surgery is the primary treatment. Understanding the strong role of inflammation in the pathogenesis of external auditory canal stenosis may lead to new preventative medical therapies. Although acquired external auditory canal was described several years ago, its underlying pathophysiology is now better understood. From this knowledge, improved medical as well as surgical approaches can be developed.

Cholesteatoma Surgery in Pneumatized and Non-pneumatized Temporal Bones

This report compares the different surgical methods for large and pneumatized mastoid cavity (large cavity) and small and poorly pneumatized mastoid cavity (small cavity) cholesteatomas and their results for the facial nerve and mastoid cavity. In the period from January 1996 to December 2000, 101 ears with cholesteatomas underwent tympanoplasty with mastoidectomy. In the large cavity group, the posterior canal wall was removed and the vertical portion of the facial nerve was skeletonized to lower the facial ridge. Partial obliteration with conchal cartilage and perichondrium at the epitympanum and mastoid tip was used to make the external auditory canal and the mastoid a smooth common cavity without reconstruction of the posterior canal wall. In the small cavity group, the facial ridge was not intentionally lowered as long as the cholesteatoma was completely removed. The whole mastoid cavity was obliterated and the posterior canal wall was reconstructed. The newly reconstructed posterior canal wall was composed of preserved facial ridge in the lower part and obliterated conchal cartilage in the upper part. There were 27 ears with large cavity cholesteatomas and 74 with small cavity cholesteatomas. The incidences of postoperative complications (large cavity versus small cavity) were: facial paralysis, 3 versus 0; minor wound infection, 2 versus 8; flap partial necrosis, 1 versus 4; cartilage partial necrosis, 0 versus 2; external auditory canal stenosis, 0 versus 2; residual drum perforation, 3 versus 3; otitis media with effusion, 3 versus 4; recurrent cholesteatoma, 0 versus 2; and residual cholesteatoma, 1 versus 2. Significantly more postoperative facial nerve paralysis in the large cavity group was correlated to skeletonization of the facial nerve and treatment of the facial ridge.

Otologic Manifestations of Malignant Osteopetrosis

To determine the incidence of hearing loss and describe the neurotologic manifestations over time in a large series of patients with malignant osteopetrosis. Longitudinal study. Tertiary care referral center. Thirty-two patients, including 19 infants (< 1 yr of age at initial visit) and 13 children (aged 1-7.6 yr at initial visit), with autosomal recessive osteopetrosis were followed-up during a 10-year period from 1991 to 2001. The average length of follow-up was 2.5 years (range, 0-9.1 yr). Patients underwent annual otologic evaluations including clinical examination, audiologic evaluation (auditory brainstem response, pure-tone thresholds, speech discrimination scores, and tympanograms), and high-resolution computed tomography of the temporal bone. Incidence of hearing loss, otitis media, and facial paralysis. Serial changes in temporal bone anatomy by computed tomographic scan. Twenty-six percent of infants' ears demonstrated hearing loss during the first year of life, and 78% of children's ears demonstrated hearing loss during the study period. Of the children's ears with hearing loss, 100% had a conductive component and 26% had an additional sensorineural component (mixed hearing loss); VIIIth nerve conduction was normal in 100% of infants and 78% of children. Five patients (16%) had unilateral facial nerve palsy. Common temporal bone findings included thickening and sclerosis of the calvarium; poor pneumatization of the mastoid bone; and narrowing of the external auditory canal, eustachian tube, and internal auditory canal. Otologic manifestations are common in malignant osteopetrosis secondary to the formation of dense, brittle bone. Frequent findings include external auditory canal stenosis, otitis media, conductive and sensorineural hearing loss, and facial nerve paralysis.

A case of fibrous dysplasia of the temporal bone

Fibrous dysplasia involving the temporal bone is unusual. The most common initial findings are stenosis of the external auditory canal and conductive hearing loss. We report a case of monostotic fibrous dysplasia of the temporal bone. The patient was a 66-year-old man, who complained of hearing loss in the left ear and swelling of the left temporal region of the head. The left external auditory canal was stenotic, so an audiogram demonstrated a conductive hearing loss. A plain skull roentgenogram and CT scan showed swelling of the left temporal bone with ground-glass appearance and bony stenosis of the left external auditory canal. Canalplasty and cranioplasty were performed by a doctor of otorhinolaryngology and plastic surgery. The left external auditory canal was opened and hearing loss was improved, and this condition was maintained for one year after the operation at our hospital. Fibrous dysplasia is one of the benign and chronic proliferations of fibrous tissue and bone. Although it produces tumorous masses, not all authors agree that the process is truly neoplastic. Most cases involve a single bone, but about 20% of patients have polyostotic involvement and often with extraosseous abnormalities. This disease produces widely variable radiographic images. Often, there is a ground-glass appearance with a density similar to that of the surrounding cancellous bone, but lacking a trabecular structure.

Otologic manifestations of ectodermal dysplasia.

To determine the range and prevalence of otologic disorders in patients with ectodermal dysplasia (ED) and provide a general review of its multiple otolaryngological manifestations. Case series. Ectodermal dysplasia family conference. Sixty-nine individuals with ED were evaluated. The average age was 11 years (range, 1-56 years). Most were male patients (44 [64%]), and most had Christ-Siemens-Touraine syndrome/hypohidrotic ED (42 [61%]), with the remaining having Hay-Wells, Clouston, and ectrodactyly ED clefting syndromes and unclassified types of ED. Questionnaire including a quality-of-life assessment modeled after the Otitis Media 6 instrument, physical examination, screening audiogram, and tympanometry. Of the 69 patients, 15 (22%) had a known history of hearing loss, and over half reported some level of difficulty processing verbal information (30 patients [43%] reported speech problems and 4 patients [6%] required hearing aids). A history of otitis media was common, with 15 patients (21%) presenting with tympanostomy tubes in place. The mean +/- SD quality-of-life rating was 2.0 +/- 1.1 (range 1-7), with lower scores suggesting less of a problem. On physical examination, 18 patients (26%) had pinna anomalies. One case of advanced cholesteatoma and 2 cases of external auditory canal stenosis were identified. Of the 24 patients who received 4-tone screening audiogram, 2 (8%) had a highest pure-tone average threshold of 50 to 65 dB, whereas 5 patients (21%) had a 30- to 45-dB threshold, with the remaining having a 0- to 25-dB threshold. In our study, which is, to our knowledge, the largest reported collection of ED patients evaluated for otologic disease, most patients were found to have 1 or more otologic abnormalities, ranging from auricular anomaly to complications of otitis media to profound hearing loss.

Congenital aural atresia surgery: long-term results.

The study goal was to evaluate the stability of hearing results from short- to long-term follow-up in patients who underwent surgery for congenital aural atresia. We also reviewed complications such as external auditory canal stenosis, lateralization and perforation of the tympanic membrane, sensorineural hearing loss, and facial palsy. We conducted a retrospective chart review of 116 patients who underwent congenital aural atresiaplasty between 1985 and 2002 at the House Ear Clinic. There were 116 atretic ears. Complication rates and short- and long-term (up to 13.6 years) hearing results were evaluated for primary and revision cases. Closure of the air-bone gap (ABG) to 30 dB or less at short-term follow-up occurred in 58.5% of primary surgeries and 56% of revisions. The long-term postoperative ABG was 30 dB or less in 50.8% of the primary cases and 39.1% of the revisions. Paired comparison analysis found no significant change in ABG from short- to long-term follow-up for either primary or revision cases. Soft tissue stenosis was seen in 8% of primary surgeries and 3.4% of revisions. Ossicular chain refixation was seen in 11.5% and 6.9% of primary and revision surgeries, respectively. There were no dead ears. Atresiaplasty surgery in individuals with congenital aural atresia can yield reliable, lasting hearing results with a low incidence of complications.

Congenital aural atresia surgery: Long-term results

The study goal was to evaluate the stability of hearing results from short- to long-term follow-up in patients who underwent surgery for congenital aural atresia. We also reviewed complications such as external auditory canal stenosis, lateralization and perforation of the tympanic membrane, sensorineural hearing loss, and facial palsy. We conducted a retrospective chart review of 116 patients who underwent congenital aural atresiaplasty between 1985 and 2002 at the House Ear Clinic. There were 116 atretic ears. Complication rates and short- and long-term (up to 13.6 years) hearing results were evaluated for primary and revision cases. Closure of the air-bone gap (ABG) to 30 dB or less at short-term follow-up occurred in 58.5% of primary surgeries and 56% of revisions. The long-term postoperative ABG was 30 dB or less in 50.8% of the primary cases and 39.1% of the revisions. Paired comparison analysis found no significant change in ABG from short- to long-term follow-up for either primary or revision cases. Soft tissue stenosis was seen in 8% of primary surgeries and 3.4% of revisions. Ossicular chain refixation was seen in 11.5% and 6.9% of primary and revision surgeries, respectively. There were no dead ears. Atresiaplasty surgery in individuals with congenital aural atresia can yield reliable, lasting hearing results with a low incidence of complications.

External auditory canal stenosis after radiation therapy.

To determine whether the risk of external auditory canal stenosis from external-beam radiation therapy is dose dependent. Retrospective chart review. The presence of external auditory canal disease was recorded for patients who received low-dose (e.g., lymphoma [20-40 Gy]), medium-dose (e.g., chemodectoma [40-55 Gy]), or high-dose (e.g., parotid and nasopharyngeal neoplasms [55-75 Gy]) external-beam radiation therapy from 6 months to over 8 years following treatment. The incidence of external auditory canal disease was compared between groups. None of 13 low-dose, none of 19 medium-dose, and 8 of 91 (8.7%) high-dose external-beam radiation therapy subjects developed ipsilateral external auditory canal stenosis. No external auditory canal stenosis developed in patients treated with high-dose external-beam radiation therapy in the absence of parotid surgery. External auditory canal stenosis developed only in patients treated with parotidectomy and high-dose external-beam radiation therapy (P =.0059), and all of these cases of external auditory canal stenosis developed within 3 years of radiation therapy. High dose external-beam radiation therapy alone does not significantly predispose patients to external auditory canal stenosis. However, combined high-dose external-beam radiation therapy and surgery around the external auditory canal do significantly increase the risk of external auditory canal stenosis.