Otology

Editors Picks

Osteoma of the middle ear

October 17, 2014     Tsung-Shun Chang, MD; Wen-Sen Lai, MD; Chao-Yin Kuo, MD; Chih-Hung Wang, MD, PhD
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Management of middle ear osteoma can be complicated when the round window is obliterated. Therefore, the patient should be informed about what to expect prior to surgery.

Basal cell carcinoma of the external auditory canal

October 17, 2014     Nai-Wei Hsueh, MD; Min-Tsan Shu, MD
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Basal cell carcinomas of the EAC are known to be locally aggressive, although they are not associated with regional lymph node metastasis.

Primary malignant melanoma of the external auditory canal extending into the preauricular area and scalp

October 17, 2014     Mainak Dutta, MS; Soumya Ghatak, MS; Ramanuj Sinha, MS, DNB
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Abstract

Malignant melanomas in the head and neck region are uncommon. When they do occur, they usually represent a metastasis. To the best of our knowledge, only 11 cases of primary malignant melanoma of the external auditory canal have been previously reported in the English-language literature since 1954. We describe a new case, which occurred in a 72-year-old woman who presented with a large, lobulated, pigmented mass with ulcerated bleeding on its surface. The patient was scheduled for surgery, but during preoperative preparations she developed signs of rapid dissemination and metastases to the liver and lungs, and she died of multiple organ failure within 3 weeks of presentation. Apart from the rarity of malignant melanoma of the external auditory canal, this case included other extraordinary features that make it noteworthy. Our experience with this case underscores the importance of early diagnosis and prompt initiation of treatment for patients with this potentially fatal malignancy.

Giant-cell tumor of the tendon sheath in the external auditory canal

October 17, 2014     Margherita Trani, MD; Massimo Zanni, MD; Paolo Gambelli, MD
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Abstract

Giant-cell tumor of the tendon sheath (GCTTS) and pigmented villonodular synovitis belong to the same type of benign proliferative lesions originating in the synovia that usually affect the joints, bursae, and tendon sheaths. They frequently involve the hands, knees, ankles, and feet. We report a case of GCTTS in the external auditory canal in a 53-year-old woman who presented with hearing loss, fullness, and a sessile lesion protruding from the anterior wall of her external ear canal. The 1.5-cm diameter mass was spherical, well encapsulated, firm, and covered with normal skin. The lesion was completely excised, and the patient's symptoms resolved. No recurrence was detected at 2 years of follow-up.

Salivary gland choristoma of the middle ear

October 17, 2014     Paolo Fois, MD; Anna Lisa Giannuzzi, MD; Carlo Terenzio Paties, MD; Maurizio Falcioni, MD
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Abstract

Choristoma of the middle ear is a rare condition characterized by the presence of normal salivary gland tissue in the middle ear space. Salivary gland choristomas are benign lesions that are frequently associated with ossicular chain and facial nerve anomalies. Total surgical excision is indicated when there is no risk of damaging the facial nerve. We describe a new case of salivary gland choristoma of the middle ear, and we discuss the etiology, histologic features, and management of such lesions. Our patient was a 22-year-old woman in whom we surgically removed a whitish retrotympanic mass. Intraoperatively, we also detected an ossicular chain malformation. Histologic examination of the choristoma revealed the presence of salivary gland tissue. Furthermore, the lesion contained an extensive and previously undescribed component: a well-defined pseudostratified respiratory-type epithelium, similar to that of a normal eustachian tube. Ten months after removal of the choristoma, we surgically repaired the ossicular chain anomalies. No recurrence was noted on follow-up.

Bilateral nontuberculous mycobacterial middle ear infection: A rare case

September 17, 2014     Ing Ping Tang, MS; Shashinder Singh, MS; Raman Rajagopalan, MS
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Abstract

Nontuberculous Mycobacterium (NTM) middle ear infection is a rare cause of chronic bilateral intermittent otorrhea. We report a rare case of bilateral NTM middle ear infection in which a 55-year-old woman presented with intermittent otorrhea of 40 years' duration. The patient was treated medically with success. We conclude that NTM is a rare but probably under-recognized cause of chronic otitis media. A high index of suspicion is needed for the diagnosis to avoid prolonged morbidity. Treatment includes surgical clearance of infected tissue with appropriate antimycobacterial drugs, which are selected based on culture and sensitivity.

Cochlear fistula in a noncholesteatomatous ear

September 17, 2014     Yoav Hahn, MD; Dennis I. Bojrab, MD
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Abstract

Bony destruction of the labyrinth is usually associated with long-standing cholesteatomatous otitis media. The promontory is not a common site for bone resorption because (1) it is not an area that is involved in accumulation of cholesteatoma perimatrix substances, (2) it is the densest bone of the human body, and (3) pressure necrosis from overlying tissue is uncommon. We report a case of cochlear erosion associated with noncholesteatomatous middle ear disease. As far as we know, this is only the second such case reported in the literature. We also review decision-making factors and techniques for the safe management of this condition.

Ear mold impression material as an aural foreign body

September 17, 2014     Yu-Hsuan Lin, MD; Ming-Yee Lin, MD, PhD
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Physicians should not rush indiscriminately into action without a careful otoscopic examination and a detailed history, to discern whether a patient has abnormal anatomy and is at risk for complications.

Cystic chondromalacia of the auricle treated with dual-plane excision with intracartilaginous dissection

September 17, 2014     Giovanni Zoccali, MD; Reza Pajand, MD; Nikolaos Vrentzos, MD; Maurizio Giuliani, MD
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Abstract

Cystic chondromalacia of the auricle is an uncommon condition in which a degenerative process occurs within the cartilage. The disorder affects young and middle-aged people. Clinically, it manifests as a painless, fluctuant swelling that frequently relapses despite various therapeutic approaches. In this article we report a typical case of cystic chondromalacia of the auricle that was successfully treated by surgery-specifically, dual-plane dissection-and we briefly review the literature.

Acoustic neuroma: An investigation of associations between tumor size and diagnostic delays, facial

August 27, 2014     Marc Olshan, MD, MBA; Visish M. Srinivasan, MD; Tre Landrum, DO; Robert T. Sataloff, MD, DMA, FACS
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Abstract

We conducted a retrospective case review to ascertain the clinical characteristics associated with acoustic neuromas and their treatment. Our study population was made up of 96 patients-41 men and 55 women, aged 17 to 84 years (mean: 54)-who had undergone treatment for acoustic neuromas and for whom necessary data were available. We compiled data on presenting symptoms, the interval from symptom onset to diagnosis, tumor size at diagnosis, facial weakness, the interval from diagnosis to surgery, the type of surgical approach, and surgical complications. Our primary goals were to determine if tumor size was correlated to (1) the interval from symptom onset to diagnosis, (2) the degree of preoperative facial weakness, and (3) surgical complications. We also sought to document various other clinical characteristics of these cases. The mean interval from the first symptom to diagnosis was 4.5 years; the time to diagnosis did not correlate with tumor size. Nor was tumor size correlated with the degree of preoperative facial weakness as determined by facial electroneurography. Surgical complications occurred in 15 of the 67 patients who underwent surgery (22.4%), and they did correlate with tumor size. The most common complications were postoperative facial weakness (13.4% of operated patients), cerebrospinal fluid leak (6.0%), and infection (3.0%). Since tumors typically grow about 2 mm per year and since larger tumors are associated with more severe symptoms and surgical complications, we expected that the time to diagnosis would correlate with tumor size, but we found no significant association.

Tympanic membrane perforation with squamous epithelial ingrowth

August 27, 2014     Danielle M. Blake, BA; Alejandro Vazquez, MD; Senja Tomovic, MD; Robert W. Jyung, MD
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The squamous epithelium of the tympanic membrane and external auditory canal exhibits an inherent migration pattern to facilitate the exfoliation of keratinizing squamous cells as part of a natural cleansing mechanism.

Fungal otitis externa as a cause of tympanic membrane perforation: A case series

August 27, 2014     James Eingun Song, MD; Thomas J. Haberkamp, MD; Riddhi Patel, MD; Miriam I. Redleaf, MD
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Abstract

We describe a series of 11 patients-8 men and 3 women, aged 18 to 70 years (mean: 46.0)-who had fungal otitis externa that had been complicated by a tympanic membrane perforation. These patients had been referred to us for evaluation of chronic, mostly treatment-refractory otitis externa, which had manifested as otorrhea, otalgia, and/or pruritus. Seven of the 11 patients had no history of ear problems prior to their current condition. Five patients had been referred to us by a primary care physician and 4 by an otolaryngologist; the other 2 patients were self-referred. All patients were treated with a thorough debridement of the ear and one of two antifungal medication regimens. Eight of the 11 patients experienced a complete resolution of signs and symptoms, including closure of the tympanic membrane perforation. The other 3 patients underwent either a tympanoplasty (n = 2) or a fat-graft myringotomy (n = 1) because the perforation did not close within a reasonable amount of time. This series demonstrates that the nonspecific signs and symptoms of fungal otitis externa can make diagnosis difficult for both primary care physicians and general otolaryngologists. This study also demonstrates that most cases of tympanic membrane perforation secondary to fungal otitis externa will resolve with cleaning of the ear and proper medical treatment. Therefore, most patients with this condition will not require surgery.