Auditory Canal

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
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Abstract

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
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Abstract

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
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Abstract

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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Auricular ossification resulting in external auditory canal stenosis

March 1, 2008     Matthew J. Carfrae, MD and David Foyt, MD
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Abstract

We report the case of a 49-year-old man who presented with left aural fullness, hearing loss, and a stenotic left external auditory meatus. Physical examination and computed tomography revealed the presence of an idiopathic ossification of the cartilaginous auricle and external auditory canal. The patient was successfully treated with meatoplasty. Pathologic examination of the removed specimen revealed osseous metaplasia.

Attic cholesteatoma

September 30, 2007     J. Walter Kutz Jr., MD; Derald E. Brackmann, MD
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A 67-year-old man presented with a long history of hearing loss. He denied otorrhea, otalgia, and a history of ear infections.

An evaluation of auditory exostoses in 621 prehistoric human skulls from coastal Brazil

July 31, 2007     Maria Mercedes M. Okumura, PhD; CĂ©lia Helena C. Boyadjian, BA; Sabine Eggers, PhD
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Abstract
Auditory exostoses are bone anomalies located on the floor of the external auditory canal. They frequently develop in individuals who participate in water sports and other aquatic activities. Their etiology is probably multifactorial; development seems to be triggered by regular exposure to cold water, as well as to low air temperatures and/or cold winds. The presence of auditory exostoses has been recorded in human skull fossils that date back approximately 250,000 years. We conducted a study of auditory exostoses in 621 skulls of adult humans who had been part of a marine-dependent population that lived on the Brazilian coast between 5,400 and 800 years ago. The overall frequency of exostoses was 22%, but there was a great variance among different subgroups (0 to 56%). In this article, we propose some possible explanations for this variance. We also hope that our study will stimulate multidisciplinary research aimed at deciphering the intricate bony messages contained in cryptic archaeologic remains.

Bilateral cerebellopontine angle metastatic melanoma: A case report

June 30, 2007     Abraham Jacob, MD; Rebecca P. Brightman, MD; D. Bradley Welling MD, PhD
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Abstract
Although melanoma accounts for approximately 1% of all malignancies, melanoma metastases to the cerebello-pontine angles (CPAs) are exceedingly rare. Here we describe a patient with melanoma metastases to the internal auditory canals and CPAs who presented with a remote history of cutaneous melanoma. This patient had a rapidly progressive hearing loss, vestibulopathy, and facial nerve dysfunction. Magnetic resonance imaging demonstrated bilateral, enhancing CPA lesions but was otherwise nonspecific. The diagnosis required a careful history, unilateral surgical resection for tissue acquisition, and histopathologic confirmation. A search for primary cutaneous melanoma at the time of presentation was negative. However, the history of cutaneous melanoma 8 years earlier distinguishes this patient's metastatic disease from solitary primary intracranial melanoma, an equally rare disease. Treatment consists of surgical excision, radiation, chemotherapy, and immunotherapy. The prognosis for patients with melanoma metastases is generally poor, but isolated reports of long-term survival have been described. Metastatic disease to the CPAs must be included in the differential diagnosis for any patient presenting with rapid-onset VIIth or VIIIth cranial nerve symptoms.

Epidermolysis bullosa

March 31, 2007     James Lin, MD; Jose N. Fayad, MD
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Amyloidosis of the external auditory canal and middle ear: Unusual ear tumor

February 1, 2007     Heitham Gheriani, FRCSI, FRCSEd; Rajesh Tewary, MD, FRCSEd; Timothy J. O'Sullivan, FRCS(C)
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Multiple angiomas of the external auditory canal in a patient with Sturge-Weber syndrome

January 1, 2007     Matthew E. Dahl, MD; Marcella Bothwell, MD; Scot D. Hirschi, MD
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Role of impacted cerumen in hearing loss

September 30, 2006     Sethu T. Subha, MS (ORL); Rajagopalan Raman, MS (ORL)
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Abstract
We performed a study to determine if cerumen in the ear canal causes significant hearing loss and to ascertain if there is any correlation between the amount of cerumen and the degree of hearing loss. Our study was conducted on 109 ears in 80 patients. The results indicated that impacted cerumen does cause a significant degree of conductive hearing loss. We found no significant correlation between the length of the cerumen plug and the severity of hearing loss. Nor did we find any significant correlation between the presence of impacted cerumen and variables such as age, sex, ethnicity, or affected side.
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