Auditory Canal

Cholesteatoma of the external auditory canal in an immunocompromised patient

September 30, 2006     Arun K. Gadre, MD; Jennifer Davies, MD
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Primary B cell lymphoma of the external auditory canal

August 31, 2006     Sheldon P. Hersh, MD; Winston G. Harrison, MD; David J. Hersh, MD
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Abstract
Temporal bone lymphomas are rare and typically metastatic neoplasms. We describe a case of primary B cell lymphoma that originated in the external auditory canal of an elderly woman. The diagnosis was based on histopathologic examination supplemented by immunophenotypic analysis. The patient was treated with external-beam radiation and remained disease-free throughout 9 years of follow-up. We also point out that the presence of non-Hodgkin's lymphoma in an unusual site may be an indication that the patient has an acquired immunodeficiency syndrome.

An unusual 'disappearing mass' in the ear canal

June 30, 2006     Eu Chin Ho, MRCS, DOHNS; Naeem Siddiqui, DLO, FRCS (ORL-HNS)
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Reconstruction of the conchal bowl and external auditory canal

June 30, 2006     Suma Susan Mathews, DLO, MS; Shiby Ninan, MS, Mch
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Exostosis of the external auditory canal

March 1, 2006     J. Walter Kutz, Jr., MD; Jose N. Fayad, MD
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An unusual site of a CSF leak following resection of a retrosigmoid acoustic neuroma

March 1, 2006     Michael P. Ondik, MD; Aaron G. Benson, MD; Hamid Djalilian, MD
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Abstract
Cerebrospinal fluid (CSF) leaks may occur after acoustic neuroma resection. These leaks are usually the result of an iatrogenic injury during removal. The retrosigmoid approach is commonly associated with leaks that occur through the lateral end of the internal auditory canal, through the perilabyrinthine cells extending to the region of the internal auditory canal, or through the retrosigmoid air cells. We describe a case of an infracochlear CSF leak that developed following the retrosigmoid resection of an acoustic neuroma. To the best of our knowledge, this leak was unique for both its location and etiology.

Safety and efficacy of Sofenz ceruminolytic solution

February 1, 2006     Aiman Midani, MD; Inez Carels, MS; Michael Marks, PhD; Michael Wall, PhD; Ear Wax Removal Solution Study Team
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Abstract
We conducted an open-label study of 109 untreated patients who had excessive or impacted cerumen. Our goal was to evaluate the safety and efficacy of Sofenz Cerumenolytic Solution, a methyltrypsin-containing earwax removal solution. Each patient's external auditory canal was filled with Sofenz for 15 minutes. The primary measure of efficacy ''visibility of the tympanic membrane'' was assessed after the solution had been drained from the canal and again after the canal had been irrigated with lukewarm water. If the tympanic membrane was not completely visible following either application, the procedure was repeated. A safety examination was conducted 1 to 3 days after treatment. Secondary outcomes measures included relief of otologic symptoms (e.g., hearing loss, tinnitus, etc.) and patients' overall satisfaction with treatment. Immediately after treatment, we found that the external auditory canal was completely visible in 81 patients (74.3%) after 1 application of Sofenz and subsequent irrigation, and in 98 patients (89.9%) after 2 applications of each. At the safety follow-up visit, we determined that the number of otologic symptoms had declined by 93.2%. A self-reported assessment completed by each patient following the procedure revealed a high degree of satisfaction with treatment. A total of 58 adverse events were reported, but only 16 were directly related to treatment, and all were transient and either mild or moderate. We conclude that 1 or 2 applications of Sofenz followed by irrigation with lukewarm water is a safe, well-tolerated, and effective treatment for excessive or impacted cerumen in the external auditory canal.

Complete medial canal fibrosis

January 1, 2006     S. Arif Ulubil, MD; Adrien A. Eshraghi, MD
article

Atypical presentation of cutaneous tuberculosis and a retropharyngeal neck abscess

January 1, 2006     Frank O. Agada, FRCS; Ravi Sharma, FRCS; Zvoru G.G. Makura, FRCS
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Abstract
A 70-year-old Asian man with noninsulin-dependent diabetes presented with a 4-month history of left-sided otitis externa and right-sided facial palsy. Physical examination of the left ear revealed a punched-out ulcerative lesion on the tragus, an edematous and inflamed external auditory canal, and a purulent nonmucoid discharge. Computed tomography of the brain and neck demonstrated a large retropharyngeal abscess, an abscess in the left parapharyngeal space, and a small collection adjacent to the right carotid sheath at the level of C4; the cervical vertebrae and lungs were normal. Microscopy of drained pus and histology of left ear and neck node biopsies identified tuberculosis. The patient was started on antituberculosis drug therapy, but he died within 2 weeks of treatment. We discuss the characteristics of this unusual presentation of tuberculosis infection.

Intraoperative use of mitomycin C in fibrous atresia of the external auditory canal

December 1, 2005     Saba Battelino, MD, MSc; Irena Hocevar-Boltezar, MD, PhD; Miha Zargi, MD, PhD
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Abstract
The ability of mitomycin C to inhibit fibroblasts in vitro has prompted its use during standard surgical procedures as a means of preventing the development of adhesions and stenosis. We conducted a prospective study to evaluate the effectiveness of topical mitomycin C in maintaining an open external auditory canal in 6 ears of 4 patients with aural fibrotic atresia who were undergoing meatoplasty. During the procedure, we applied 1 ml of mitomycin C (0.4 mg/ml) for 4 minutes to the external auditory canal (in 1 case, mitomycin C was reapplied to an ear 1 month later). Between 3 and 14 months postoperatively, the patency of the ear canal was assessed visually and hearing was evaluated audiometrically. Adequate patency was achieved in 5 of the 6 ears (83.3%), and the air-bone gap in these 5 ears had improved to 10 dB or less. No postoperative complications or sensorineural hearing loss was observed. In this very limited number of cases, we found that the intraoperative use of mitomycin C appeared to have been helpful in preventing scarring in both congenital and secondary fibrotic atresias of the external auditory canal. These preliminary results are encouraging, and a prospective, placebo-controlled study appears to be warranted.

Angioleiomyoma of the internal auditory meatus: A rare occurrence in the internal auditory canal

April 1, 2005     Yakubu G. Karagama, MRCS, DLO; Lindsey R. Bridges, FRCPath; Philip T. van Hille, FRCS
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Abstract
We describe a case of angioleiomyoma of the internal auditory meatus. A finding of this tumor at this site is very unusual. In fact, our review of the literature revealed that only 1 case has been previously reported. In our patient, the tumor was clinically and radiologically difficult to distinguish from an acoustic neuroma. It would be important to recognize this rare small tumor preoperatively because it may be appropriate to manage it conservatively.

External auditory canal polyp

March 1, 2005     John W. House, MD; Jose N. Fayad, MD
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