Auditory Canal

External ear canal cholesteatoma

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

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


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.

Exostoses of the external auditory canal

May 31, 2010     Jeffrey Nau, MD and Arun K. Gadre, MD, FACS

Amyloidosis of the external auditory canal

April 30, 2010     James J. Klemens, MD, Wendy Recant, MD, Joseph M. Baron, MD, and Miriam I. Saadia-Redleaf, MD


We present a case of bilateral otitis externa that did not respond to local treatment. Cutaneous biopsies revealed bilateral amyloid depositions secondary to multiple myeloma. Persistent, identical bilateral canal lesions may be the only manifestation of treatable systemic disease and should be biopsied, even though their bilaterality argues against malignancy.

Hemangiopericytoma presenting as an external auditory canal mass

April 30, 2010     Sampan S. Bist, MS, Saurabh Varshney, MS, Rakesh Kumar, MS, and Nitin Gupta, MS

Myxoma of the temporal bone: An uncommon neoplasm

March 1, 2010     Deepika Sareen, MBBS, Ashwani Sethi, MS, Sumit Mrig, MBBS, Sonu Nigam, MD, and A.K. Agarwal, MS


We report the case of an 11-year-old girl who presented with a soft-tissue mass that filled the left external auditory canal and a discharge that resembled chronic suppurative otitis media. The patient underwent mastoid exploration with complete excision of the mass. Findings on the excision biopsy were consistent with a myxoma of the temporal bone. At follow-up 2 years postoperatively, the patient remained disease-free. To the best of our knowledge, this is only the 12th case of a myxoma of the temporal bone to be reported in the English-language literature.

Pleomorphic adenoma of the external auditory canal: A case report and review of the literature

March 1, 2010     Lisa Skultety Ayers, DO, Kalpana DePasquale, DO, Frank I. Marlowe, MD, and Mahmoud Ghaderi, DO


Pleomorphic adenomas of the external auditory canal (EAC) are benign tumors of the ceruminal glands; they are a rare entity. Arising from the lateral cartilaginous portion of the EAC, these lesions can be challenging to diagnose in view of their rare clinical presentation, indolent symptoms, and a lack of familiarity on the part of histopathologists. We report the case of a pleomorphic adenoma in a 32-year-old woman, and we review the literature on glandular neoplasms of the EAC, with particular emphasis on terminology and factors that can hinder the diagnosis.

Keratin pearl

January 1, 2010     Omar Rahmat, MS (ORL), Rajagopalan Raman, MS (ORL), and Hisyam Salleh, MBBS

Mastoid pneumocele with secondary pneumatocele causing external auditory canal obstruction and the influence of forced nose blowing

January 1, 2010     Geert Delabie, MD, Frans Gordts, MD, PhD, and Peter A.R. Clement, MD, PhD


We present a case involving a 36-year-old man who had a feeling that his right ear was obstructed and who had associated conductive hearing loss that was exacerbated by nose blowing. On otoscopy, a soft-tissue swelling was seen in the posterosuperior aspect of the right external auditory canal. Computed tomography revealed the presence of hyperaerated mastoid air cells and an air-containing cavity connected with the enlarged mastoid air cells, narrowing the external auditory canal. A radiographic diagnosis of a mastoid pneumocele with secondary pneumatocele was made. A novel hypothesis is presented, that high nasal pressures play an important role in the progressive formation of a pneumocele/pneumatocele as a result of air invasion via the eustachian tube. Symptoms disappeared after a myringotomy tube was placed. Computed tomography performed 6 months later showed an impressive remodeling of the temporal bone

External auditory canal cholesteatoma: A rare complication of tympanoplasty

October 31, 2009     Borlingegowda Viswanatha, MS, DLO


The author describes a rare case of external auditory canal cholesteatoma. This particular case occurred in a 20-year-old woman who had undergone a tympanoplasty 1 year earlier. Previous tympanoplasty is one of several known predisposing factors for external auditory canal cholesteatoma. The mass was excised, and it was diagnosed on histopathology. The patient recovered uneventfully.

Tympanum-canal angles anteriorly, anteroinferiorly, and inferiorly: A postmortem study of 41 adult crania

August 31, 2009     N. Wendell Todd, MD, MPH


The angles formed by the tympanic membrane and the external ear canal anteriorly, anteroinferiorly, and inferiorly can pose surgical challenges, and the spaces they form can harbor iatrogenic cholesteatoma. The range of values previously reported for these angles-27° to 60°-seems not to have been determined in a clinically applicable manner. To clinically describe the tympanum-canal angles, assess bilateral symmetry, assess the angles relative to mastoid pneumatization, and assess the relationship of the angles to manubrium orientation in the skull, the author conducted a postmortem anatomic study of 41 bequeathed adult crania without clinical otitis media. As viewed through the external ear canal, the tympanum-canal angles were measured in 10° increments anteriorly, anteroinferiorly, and inferiorly relative to the line of the manubrium. Mastoid sizes were determined radiographically. In the right ear, the tympanum-canal angles ranged from 40° to 60° anteriorly (median: 55°), from 50° to 70° anteroinferiorly (median: 60°), and from 70° to 80° inferiorly (median: 75°). Bilateral symmetry was found (each rs ≥ 0.69, p < 0.001). Although the angles did not correlate with either mastoid pneumatization or manubrium orientation relative to the Frankfort plane, nonvisualization of the annulus anteriorly was significantly more common in specimens with well-pneumatized mastoids (p < 0.05). The author concludes that the tympanum-canal angles anteriorly, anteroinferiorly, and inferiorly have comparatively narrow ranges, exhibit bilateral symmetry, and are unrelated to both mastoid size and manubrium orientation in the skull.

Foreign body in the external auditory canal

June 30, 2009     Mary Burton, AuD and Arun K. Gadre, MD
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