External Ear Canal Cholesteatoma Research Articles

Recurrent Ear Discharge in Primary Care: Exploring the Possibility of Cholesteatoma - A Case Report

Cholesteatoma is a benign lesion of the keratin-producing squamous epithelium, most commonly arising in the middle ear and mastoid. It is rarely found within the external auditory canal. It presents mainly as unilateral lesions and is often destructive and locally invasive. Hence, early detection and referral to an otorhinolaryngology specialist are warranted due to its grave sequelae. This report is about a rare and atypical case of an external ear canal cholesteatoma (EECC) in a young patient. The diagnosis and referral were delayed due to the nature of the disease that resembles an infection, the rarity and atypical presentation of the case, and a low index of suspicion. Therefore, a high index of suspicion based may lead to a timely diagnosis, management, prevention of serious complications, and optimal preservation of ear function.International Journal of Human and Health Sciences Vol. 08 No. 02 Apr’24 Page: 215-219

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.

Abnormal bone loss in the external auditory canal of two adult humans from the medieval period of Germany—An attempt at differential diagnosis

AbstractAbnormal loss of bone in the external auditory canal (EAC) constitutes an underreported condition in paleopathology. Thus far, all reported cases were diagnosed as the result of an external ear canal cholesteatoma (EACC). Here, we report two cases from the medieval period in Germany that show enlarged EACs with perforations of the anterior and posterior EAC walls. The cases were studied macroscopically, with a digital stereo microscope and by conventional X‐ray and computed tomography (CT)‐imaging techniques. In Case 1, the resorption caused a “ballooning” of the EAC while signs of osteonecrosis were missing. We therefore conclude that keratosis obturans (KO) is the most likely diagnosis. In Case 2, the periantral region adjacent to the perforations of the posterior EAC wall exhibits large resorption cavities and sequestrum‐like structures, indicative of osteonecrosis. In this case, we arrive at the diagnosis EACC. Ear diseases encompass a broad spectrum of conditions, many of them with potentially severe impacts on past people. It is therefore suggested to address ear diseases more frequently in paleopathology. Thus far, only a very limited number of entities of ear diseases have been diagnosed in paleopathological studies, and no case of KO has been reported. The present study thus expands the spectrum of paleo‐otopathological diagnoses.

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

Application of high resolution computer tomography in external ear canal cholesteatoma diagnosis

ObjectiveTo evaluate High Resolution Computer Tomography (HRCT) in the diagnosis of external ear canal cholesteatoma. MethodsIn this retrospective study, HRCTs of 27 patients with external ear canal cholesteatoma were reviewed. The changes in the external ear canal, tympanic membrane (TM), scutum, tympanum and mastoid were measured and categorized. ResultsFourteen patients showed no or mild destruction in the external ear canal (stage I group). Eight patients had obvious enlargement in the external ear canal (stage II group) but showed limited destructions of the mastoid bone and no damage of the tympanums. Five patients had serious destruction of the mastoid bone and damage of the tympanum (stage III group). All patients in the stage III group showed a compression of manubriums and TMs, with 3 having damages on ossicular chain. Bone destruction of the vertical section of facial nerve canal was discovered in one case in the stage III group. ConclusionHRCT can provide detail information about the extent of external ear canal cholesteatoma. Such information can be used to identify special situations with serious complications and to differentiate external ear canal cholesteatoma from middle ear cholesteatoma.

Operative management of external auditory canal cholesteatoma: case series and literature review

To describe the clinical features of external auditory canal cholesteatoma, and to assess the outcome following bony meatoplasty with tragal cartilage and perichondrium graft repair. A retrospective review was carried out, comprising all patients with external auditory canal who presented between January 2007 and December 2011. Patients underwent pre-operative audiometry and computed tomography imaging of the temporal bones, before undergoing bony meatoplasty via a postauricular incision. Pre- and post-operative comparisons were made of patients’ otological symptoms and the otoscopic appearance of the external ear canal. Eight patients were included in the analyses. The median age of patients was 46.5 years (range 14–68 years), with a male to female ratio of 1:1. The median length of follow up was 16 months. The most common presenting features were unilateral otalgia and purulent otorrhoea. All patients had relatively advanced disease at presentation, with erosion of the temporal bone. All patients underwent bony meatoplasty via a postauricular approach to eradicate the disease. Bony meatoplasty was successful in the definitive management of external ear canal cholesteatoma.

Keratinosis: A New Entity in the Tropics?

A patient presented with the symptoms of ear block, itching and whitish exudates from the left ear. There was no history of pain, foul smell, tinnitus, or giddiness. Clinical examination revealed whitish keratin like substance filling the external auditory canal. There was no foul odor like cholesteatoma. There was no pain on pulling the pinna to indicate an acute external otitis. Tuning fork tests revealed a mild conductive hearing loss with Rinne test positive and weber lateralizing to the left ear. After a suction toilet of the ear, the tympanic membrane looked normal with no attic or any perforation of the ear drum. The skin of external ear canal was not inflamed. The canal was not widened. There was an absence of wax. Repeated ear swabs did not grow any organisms. Histopathology was keratin. The remaining parts of the external ear including pinna and tragus were normal with no signs of allergic skin reaction. The other ear and rest of otolaryngological examination was normal. A dermatology consultation did not reveal any other skin pathologies. Hence steroid cream (betamethasone) was applied to the external canal after an ear toilet, with instructions to avoid water getting into the ears. This was repeated on a weekly basis. The external auditory canal was back to normal in 3 weeks time. This patient was followed up for 6 months period up to date on a monthly basis and there has been no recurrence. Normal wax had started to be secreted. This condition has been seen and treated by me in a similar fashion for another 10 patients including children, with similar results. However for children and infants since toileting is difficult and hesitancy to application of a steroid cream, olive oil drops two or three times daily for a period of 3 weeks usually clears up this condition. Since this does not fit in with an external otitis acute/chronic of an infective, seborrheic or allergic type, keratosis obturans or an external ear canal cholesteatoma, I feel it is a hitherto undescribed entity. I have worked in the UK, gulf (Oman), and India and not seen a similar condition elsewhere in my 40 years of otolaryngology practice and hence this report

External ear canal cholesteatoma after ventilation tube insertion and mastoidectomy

Etiopathogenetically, there are two types of chollesteatomas: congenital, and acquired. Numerous theories in the literature try to explain the nature of the disease, however, the question about cholesteatomas remain still unanswered. The aim of the study was to present a case of external ear canal cholesteatoma (EEC) developed following microsurgery (ventilation tube insertion and mastoidectomy), as well as to point ant possible mechanisms if its development. A 16-year-old boy presented a 4-month sense of fullness in the ear and otalgia on the left side. A year before, mastoidectomy and posterior atticotomy were performed with ventilation tube placement due to acute purulent mastoiditis. Diagnosis was based on otoscopy examination, audiology and computed tomography (CT) findings. CT showed an obliterative soft-tissue mass completely filled the external ear canal with associated erosion of subjacent the bone. There were squamous epithelial links between the canal cholesteatoma and lateral tympanic membrane surface. They originated from the margins of tympanic membrane incision made for a ventilation tube (VT) insertion. The position of VT was good as well as the aeration of the middle ear cavity. The tympanic membrane was intact and of normal appearance without middle ear extension or mastoid involvement of cholesteatoma. Cholesteatoma and ventilation tube were both removed. The patient recovered without complications and shortly audiology revealed hearing improving. Follow-up 2 years later, however, showed no signs of the disease. There could be more than one potential delicate mechanism of developing EEC in the ear with VT insertion and mastoidectomy. It is necessary to perform routine otologic surveillance in all patients with tubes. Affected ear CT scan is very helpful in showing the extent of cholesteatoma and bony defects, which could not be assessed by otoscopic examination alone.

First and second branchial arch syndrome resembling external ear canal cholesteatoma

First and second branchial arch syndrome resembling external ear canal cholesteatoma

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.

Cholesteatoma of the external ear canal: etiological factors, symptoms and clinical findings in a series of 48 cases.

BackgroundTo evaluate symptoms, clinical findings, and etiological factors in external ear canal cholesteatoma (EECC).MethodRetrospective evaluation of clinical records of all consecutive patients with EECC in the period 1979 to 2005 in a tertiary referral centre. Main outcome measures were incidence rates, classification according to causes, symptoms, extensions in the ear canal including adjacent structures, and possible etiological factors.ResultsForty-five patients were identified with 48 EECC. Overall incidence rate was 0.30 cases per year per 100,000 inhabitants. Twenty-five cases were primary, while 23 cases were secondary: postoperative (n = 9), postinflammatory (n = 5), postirradiatory (n = 7), and posttraumatic (n = 2). Primary EECC showed a right/left ratio of 12/13 and presented with otalgia (n = 15), itching (n = 5), occlusion (n = 4), hearing loss (n = 3), fullness (n = 2), and otorrhea (n = 1). Similar symptoms were found in secondary EECC, but less pronounced. In total the temporomandibular joint was exposed in 11 cases, while the mastoid and middle ear was invaded in six and three cases, respectively. In one primary case the facial nerve was exposed and in a posttraumatic case the atticus and antrum were invaded. In primary EECC 48% of cases reported mechanical trauma.ConclusionEECC is a rare condition with inconsistent and silent symptoms, whereas the extent of destruction may be pronounced. Otalgia was the predominant symptom and often related to extension into nearby structures. Whereas the aetiology of secondary EECC can be explained, the origin of primary EECC remains uncertain; smoking and minor trauma of the ear canal may predispose.

Palaeo-otology of cholesteatoma

A cholesteatoma is a collection of dead epithelial cells in the ear which becomes infected with low-grade pathogenic microorganisms. The lesion tends to cause resorption of the surrounding bone, which potentially permits its recognition in skeletal remains. Cholesteatoma may occur in the middle or the outer ear. Using two examples of cholesteatoma in skeletal remains from British archaeological sites, the differential diagnosis of cholesteatoma from other aural diseases is demonstrated. Some of the differences in bony lesions caused by middle ear and external ear canal cholesteatoma which may enable the two to be distinguished in palaeopathological specimens are discussed. Attention is drawn towards the importance of making this distinction in ancient skeletal remains; middle ear and external ear canal cholesteatoma have a different array of causes and very different impacts upon health status. Copyright © 2005 John Wiley & Sons, Ltd.

Fibrous Dysplasia of the Temporal Bone: Assessment by Three-Dimensional Helical CT Imaging

Fibrous dysplasia (FD) is a bone disorder of unknown origin. Histopathologically, the affected bone contains disorganized bony trabeculae and spindle cells surrounded by a fibrous matrix. Expansion of the lesion and the resultant pressure may produce thinning of the overlying cortical bone, but the lesion does not invade the surrounding normal tissues. Fibrous dysplasia occasionally affects the temporal bone and may cause significant facial deformity and conductive hearing loss due to compression of the external auditory canal. External ear canal cholesteatoma may develop when the aperture of the external ear canal becomes extremely narrow. In such cases, surgical treatment, such as removal of the lesion causing facial deformity and reconstruction of the external ear canal, needs to be provided. We report here 2 cases of FD of the temporal bone and provide a demonstration of the usefulness of 3D-helical CT in patient management. http://www.entnet.org/journal/casereports/OTO-14.pdf/

Medial Canal Fibrosis: Surgical Technique, Results, and a Proposed Grading System

To report the hearing and surgical results in patients with medial canal fibrosis. To describe the surgical technique for removal of medial canal fibrosis and to propose a classification for grading postoperative surgical outcome and to correlate this with hearing results. Tertiary university referral center. Retrospective case review. Twenty-one patients with mature medial canal fibrosis underwent a total of 26 operations at our institution from February 1994 to June 2003. Four patients underwent surgery for bilateral disease and another had a second operation for recurrence. According to the proposed grading system, 10 (38.5%) of the 29 ears operated on achieved a Grade I result (normal self-cleaning ears) and three (11.5%) had recurrence (Grade III). One patient was found to have external ear canal cholesteatoma. Postoperatively, 15 ears demonstrated closure of the air-bone gap to within 10 dB or improvement on four-frequency average pure-tone audiogram to better than 25 dB. The mean preoperative air-bone gap was 28.7 dB compared with 12.5 dB postoperatively (p < 0.001). When hearing results were correlated with postoperative grade, 90.0% of the ears with a Grade I result had significant hearing improvement, 46.2% in patients with Grade II and 33.3% in patients with Grade III results. Four patients complained of temporomandibular joint pain postoperatively. Surgery remains the treatment of choice for mature medial canal fibrosis. With proper surgical technique and meticulous postoperative care, a patent and functioning external ear canal can be achieved in a majority of patients. Absence of recurrence does not equate with improved hearing thresholds.

Keratosis obturans and external ear canal cholesteatoma: how and why we should distinguish between these conditions

Keratosis obturans and external ear canal cholesteatomas have been considered as separate entities for the last 20 years, after being regarded as variations of the same disease for at least 87 years. While both disorders are distinct, they do have some overlapping characteristics which may make it difficult to reach a definite diagnosis. This review explores the diagnostic dilemmas which may arise, and discusses the classification, aetiology, pathogenesis and management of these conditions. We concur that external ear canal cholesteatoma and keratosis obturans are different conditions and conclude that the presence of osteonecrosis and focal overlying epithelial loss are the most reliable features favouring the diagnosis of external ear canal cholesteatoma over keratosis obturans. Furthermore, whilst keratosis obturans can be managed successfully by regular aural toilet, external ear canal cholesteatoma may require surgical intervention depending on the extent of the disease.

Estudo comparativo de aspectos histológicos e imunohistoquímicos entre o colesteatoma espontâneo do meato acústico externo e o colesteatoma adquirido da orelha média

OBJETIVO: Neste trabalho foram avaliadas as características histológicas e imunohistoquímicas (Ki-67 e CK-16) do colesteatoma espontâneo do meato acústico externo comparando-as com as do colesteatoma adquirido da orelha média. FORMA DE ESTUDO: Caso controle. MATERIAL E MÉTODO: Fragmentos de colesteatoma do meato acústico externo foram submetidos a estudo histológico e imunohistoquímico com o intuito de verificar a expressão da CK16 e do antígeno nuclear Ki-67 nas células de sua matriz, e os resultados foram comparados com os encontrados no colesteatoma adquirido da orelha média. RESULTADOS: Os aspectos histológico e imunohistoquímico quanto à presença da CK16 e do antígeno nuclear Ki-67 na matriz do colesteatoma do meato acústico externo foram idênticos àqueles encontrados no colesteatoma adquirido da orelha média. DISCUSSÃO: Acreditamos que a ocorrência do colesteatoma do meato acústico externo seja devido ao comportamento anormal de células com potencial hiperproliferativo no epitélio do meato. Este potencial estaria relacionado com a presença da CK16 em uma região onde estes marcadores não são usualmente encontrados. Esta característica hiperproliferativa do colesteatoma do meato fica patente pela presença do antígeno nuclear Ki-67 nas células suprabasais de sua epiderme. Possivelmente esta doença deve ser desencadeada pela interação desta citoqueratina (CK16) com citocinas presentes no tecido conjuntivo subepitelial inflamado, como a TGF-&lt;FONT FACE=Symbol&gt;µ&lt;/FONT&gt;. CONCLUSÃO: As características histológicas (presença de cones epiteliais) e histoquímicas (expressão da CK16 e do antígeno nuclear KI-67) são idênticas no colesteatoma adquirido da orelha média e no colesteatoma espontâneo do meato acústico externo.

Expression of vascular endothelial growth factor in external auditory canal cholesteatoma

External ear canal cholesteatoma (EACC) is an invasive and destructive chronic inflammation based on the uncontrolled proliferation of the keratinocytes with an osteolytic character predominantly present in the inferior part of the auditory canal. EACC is a rare otologic entity and the incidence is estimated about 1 patient per 1000 new otologic patients. Although, EACC was described already in 1850, the cause is still unknown. Poor blood supply resulting in hypoxia is assumed to be the major etiologic factor for establishing EACC. VEGF is known to be one of the most important regulators of angiogenesis predominantly released in hypoxic conditions. VEGF is thought to play an important role in many regulatory pathways besides angiogenesis. In order to reveal the role of VEGF in the pathogenesis of EACC we determined the difference of the VEGF-expression in EACC and normal auditory meatal skin (AMS). EACC samples showed an increased expression of VEGF in all layers of the EACC-epithelium whereas AMS was predominantly reactive in the basal layers. The underlying stroma exhibited different stain-intensity which was correlating to the density of inflammatory cells. In summary poor blood supply results in hypoxic conditions which supports epithelial migratory disturbances of the auditory meatal duct. In order to improve hypoxia VEGF is released to induce angiogenesis. One of the results is migration of the keratinocytes proliferating into adjacent tissue. This study revealed an increased expression of VEGF in all layers of the EACC-epithelium. Therefore it is considered that up-regulation of VEGF enables and supports the pathogenesis of EACC, and VEGF seems to be a pivotal factor for the manifestation of EACC. This is the first study describing VEGF expression in EACC and its difference to AMS.

Chirurgie des Gehörgangs - Cholesteatoms

Aseptic necrosis and cholesteatoma of the external auditory canal can be stages of the same pathological entity. The majority of these patients suffered from symptoms similar to those of external otitis. It is suggested that minor mechanical trauma, e.g. cotton lip swabs, plays a role in the pathogenesis of external ear canal cholesteatoma. During the last 10 years we have been surgically treating 22 patients with diagnosis of aseptic necrosis and cholesteatoma of the bony external auditory canal. All 22 patients registered significant postoperative improvement.