Auditory Canal

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
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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.

Seborrheic keratosis of the external auditory canal

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

Meningioma mimicking vestibular schwannoma

July 13, 2011     Sung Won Chae, MD and Moo Kyun Park, MD
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Spontaneous posterior wall external canal cholesteatoma

July 13, 2011     Luca Oscar Redaelli de Zinis, MD
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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
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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
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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
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Abstract

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
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Abstract

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
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External ear canal cholesteatoma

August 31, 2010     Murat Topdag, MD and Efser Can, MD
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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
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Abstract

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.

Therapeutic approaches to complicated cholesteatoma of the external auditory canal: A case of associated facial paresis

July 31, 2010     Malek Belcadhi, MD, Houda Chahed, PhD, Radhouane Mani, MD, and Kamel Bouzouita, MD
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Abstract

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.

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