April 17, 2013 Min-Tsan Shu, MD; Kang-Chao Wu, MD; Yu-Chun Chen, MD
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The differential diagnosisfor cavernous hemangioma of the external auditory canal includes attic cholesteatoma with aural polyp, glomus tumor, arteriovenous malformation, granulation tissue, and carcinoma of the EAC.
January 24, 2013 Leonardo Manzari, MD; Paola Scagnelli, MD
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Abstract
Superior semicircular canal dehiscence and an abnormally wide internal auditory meatus are clinical entities characterized by vestibular and cochlear symptoms. These symptoms are induced by hypersensitivity of labyrinthine receptors secondary to a bone defect of the otic capsule. We report the case of a 41-year-old man with congenital right-sided hearing loss who presented with bilateral superior semicircular canal dehiscence that was associated with wide, bulbous internal auditory meatus and a loss of the bony wall separating the lateral end of the meatus from the cochlea. The patient was experiencing vestibular and cochlear symptoms in the right ear and disabling tinnitus in the left ear. However, he refused all treatment and was lost to follow-up.
December 31, 2012 Nuno Marcal, MD; Sofia Campelos, MD; Luis Dias, MD; Matos Goncalves, MD; Gabriel Pereira, MD; Tiago Godinho, MD
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Abstract
Primary cutaneous T-cell lymphoma is rare. Cutaneous lymphoma is defined as primary when there is an absence of nodal or systemic disease during the first 6 months following diagnosis. We report what we believe to be the first documented case of a primary cutaneous CD30-positive anaplastic large-cell lymphoma of the external auditory canal. The patient was an elderly woman who presented with progressively worsening right otalgia and hypoacusis. Otoscopy revealed an erythematic, ulcerative, nonbleeding, localized lesion in the anterosuperior area of the external auditory canal. The patient underwent an excisional biopsy, and after the diagnosis was established, she underwent 22 sessions of radiotherapy. During follow-up, she exhibited no evidence of recurrence.
October 31, 2012 Moshe Hain, MD; Edit Feldberg, MD; and Doron Halperin, MD
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Abstract
We report the case of a 73-year-old man who developed metastatic small-cell lung cancer to the bony external auditory canal (EAC). The patient had only recently been diagnosed with his primary carcinoma. The metastasis presented as a bulky, fleshy, bleeding mass in the right EAC. Biopsy of the metastasis revealed that its histologic characteristics were identical to those of the primary. This case is of interest because this was a unique type of metastasis to the EAC. Although there are reports in the literature of lung cancer and even small-cell cancer metastasizing to the temporal bone, we could find no previously published report of a small-cell lung carcinoma metastasizing to the EAC.
August 10, 2012 Kai-Chieh Chan, MD; Chi-Ju Yeh, MD; Wan-Ling Ho, MD
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Intradermal melanocytic nevi are usually asymptomatic, but a patient with such a lesion in the external auditory canal can present with aural obstruction and conductive deafness.
July 5, 2012 Joseph A. Ursick, MD; Derald E. Brackmann, MD
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External auditory canal cholesteatomas, which result from the deposition of squamous epithelium deep to the skin of the external canal, can be caused by postsurgical implantation, radiation, or trauma.
July 5, 2012 Andrew I. Ahn, MD; Mary K. Wren, MD; Ted A. Meyer, MD, PhD
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Abstract
Skull base plasmacytomas are rare and difficult to differentiate clinically and radiologically from other tumors of the head and neck. Because of the risk of progression to multiple myeloma, early diagnosis is essential. We report the case of a 65-year-old woman who presented with left-sided conductive hearing loss and an external auditory canal mass. The tumor was removed along with much of the tympanic membrane, and it was found to be a plasmacytoma. The patient was subsequently diagnosed with multiple myeloma and treated with chemoradiation before being lost to follow-up.
June 4, 2012 Lisa Cramer, BA; Dina M. Emara, MBBCh; Arun K. Gadre, MD, FACS
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Despite common belief, Mycoplasma pneumoniae is an extremely rare causative agent for bullous myringitis. Instead, it is caused by the same organisms responsible for acute otitis media.
March 1, 2012 Borlingegowda Viswanatha, MS, DLO, Dadarao Sumatha, MBBS, and Maliyappanahalli Siddappa Vijayashree, MBBS, MS
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Abstract
A comparative clinical study was carried out that included 50 cases of otomycosis in immunocompetent patients and 50 cases of otomycosis in immunocompromised patients. Clinical presentation, predisposing factors, mycologic profile, and treatment outcomes were compared. Aspergillus spp were the most commonly isolated fungi in the immunocompetent group, and Candida albicans in the immunocompromised group. Bilateral involvement was more common in the immunocompromised group. All the patients were treated with topical clotrimazole ear drops. Four patients in the immunocompromised group did not respond to treatment with clotrimazole but were treated successfully with fluconazole ear drops. Three patients had a small tympanic membrane perforation due to otomycosis.
March 1, 2012 Andrew J. Ebelhar, BS and Arun K. Gadre, MD, FACS
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Single osteomas can be removed surgically via one of two routes, depending on their location. Those arising lateral to the isthmus of the external auditory canal can be removed under local anesthesia using a transmeatal approach; those arising medial to the isthmus should be removed under general anesthesia using a postauricular approach.
February 18, 2012 Fabiana Pirani Carneiro, MD, Leonora Maciel de Souza Vianna, MD, Aline Marques dos Santos, MD, Igor Teixeira Raymundo, MD, and Ana Emília Borges de Azevedo, MD
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Abstract
Folliculosebaceous cystic hamartoma (FSCH) is a cutaneous hamartoma of pilosebaceous origin that usually occurs on the face. We present what we believe is only the second reported case of FSCH of the external auditory canal, and the first in an adult. The patient was a 59-year-old woman who presented with a 4-year history of a firm nodule on the left external auditory canal that had caused hearing loss, pruritus, and pain. The lesion was excised, and histopathologic examination identified infundibular cysts, hyperplasia of the sebaceous lobules, and a large amount of mucin, features that are consistent with FSCH. One year postoperatively, the patient was asymptomatic, and no evidence of recurrence was noted.
December 15, 2011 Edward D. McCoul, MD, MPH and Matthew B. Hanson, MD
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Abstract
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.
