Auditory Canal

Osteoma of the external auditory canal

March 1, 2012     Andrew J. Ebelhar, BS and Arun K. Gadre, MD, FACS

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.

Folliculosebaceous cystic hamartoma of the external auditory canal in an adult

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


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.

External auditory canal cholesteatoma and keratosis obturans: The role of imaging in preventing facial nerve injury

December 15, 2011     Edward D. McCoul, MD, MPH and Matthew B. Hanson, MD


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.

Seborrheic keratosis of the external auditory canal

October 26, 2011     Wan-Ling Ho, MD and Kai-Chieh Chan, MD

Type 1 first branchial cleft anomaly: Duplication of the external auditory canal

July 13, 2011     Matthew L. Carlson, MD, David J. Archibald, MD, and Shelagh A. Cofer, MD

Meningioma mimicking vestibular schwannoma

July 13, 2011     Sung Won Chae, MD and Moo Kyun Park, MD

Spontaneous posterior wall external canal cholesteatoma

July 13, 2011     Luca Oscar Redaelli de Zinis, MD

Otomyiasis of the mastoid cavity: An unusual complication of cotton-swab use

June 13, 2011     Chaudhary F. Riaz, BSc, BM, MRCS, DOHNS, Owen Judd, MRCP, MRCS, DCH, and Peter J. Conboy, FRCS

A case of a coexisting aberrant internal carotid artery and persistent stapedial artery: The role of MR angiography in the diagnosis

April 30, 2011     Hatice Gul Hatipoglu, MD, Mehmet Ali Cetin, MD, Enis Yuksel, MD, and Huseyin Dere, MD


We describe the case of a 37-year-old woman who presented with a complaint of recurrent headaches since childhood. Clinical examination revealed the presence of a reddish-bluish mass in the inferior half of the tympanic membrane in her right ear. Source and three-dimensional time-of-flight magnetic resonance angiography (MRA) detected a protruded right internal carotid artery (ICA) in the hypotympanum. The vertical segment of the ICA was absent, and the artery was narrowed and lateralized and had a “reverse 7” shape. Meanwhile, a persistent stapedial artery (PSA) was seen originating in the petrous portion of the ICA to form a middle meningeal artery. The A1 segment of the right anterior cerebral artery was hypoplastic. Based on these findings and on follow-up findings on computed tomography, the patient was diagnosed with a concomitant aberrant ICA and PSA. No intervention was undertaken. We review the management of this rare finding, and we discuss the role of MRA in its diagnosis.

Cholesterol granuloma of the external ear canal: A rare presentation

December 17, 2010     Kang-Chao Wu, MD, Min-Tsan Shu, MD, and Cheng-Chien Yang, MD


Almost all aural cholesterol granulomas develop in the mucosa of the middle ear. We describe the case of a 14-year-old girl who presented with an asymptomatic, nontender, dark-blue, cystic lesion in the posteroinferior portion of the left ear canal. The mass was excised via a postauricular approach. Postoperatively, the mass was identified as a cholesterol granuloma on pathologic examination. To the best of our knowledge, this is the first reported case of a human cholesterol granuloma limited to the external ear canal.

Congenital tympanic ring defect presenting as an external auditory canal mass

September 30, 2010     Amy P. Wu, MD and Daniela Carvalho, MD

Extensive external auditory canal cholesteatoma in the infratemporal area without mastoid involvement: Use of a new surgical technique

August 31, 2010     Jun Ho Lee, MD, Sang Ho Jung, MD, Chan Hum Park, MD, and Seok Min Hong, MD


The external auditory canal (EAC) is an unusual location for a cholesteatoma. We present the cases of 2 patients with EAC cholesteatoma who experienced extensive damage that extended from the inferior EAC wall to the infratemporal area; there was no mastoid involvement. In both cases, the cholesteatomas were removed under local anesthesia and the inferior canal wall was reconstructed with a technique that involved the placement of a pedicled musculoperiosteal flap, a cartilage graft, and a full-thickness skin graft. This simple procedure preserves a normal EAC contour, middle ear space, and mastoid cavity.

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