|Year : 2017 | Volume
| Issue : 4 | Page : 230-232
Outer auditory canal cholesteatoma
Hitesh Verma1, Arjun Dass2, Surinder K Singhal2, Nitin Gupta2
1 Department of Otorhinolaryngology and Head and Neck Surgery, AIIMS, New Delhi, India
2 Department of Otorhinolaryngology and Head and Neck Surgery, GMCH, Chandigarh, India
|Date of Web Publication||12-Dec-2017|
Dr. Hitesh Verma
Department of Otorhinolaryngology and Head and Neck Surgery, Fourth Floor, Teaching Block, AIIMS, New Delhi
Source of Support: None, Conflict of Interest: None
Outer auditory canal cholesteatoma (OACC) is a rare form of cholesteatoma of temporal bone, and it accounts for 0.1%–0.5% of new patients at clinics of otolaryngologist. We are presenting here a rare case of cholesteatoma of OAC where excision was done with canal wall down mastoidectomy with preservation of tympanic membrane and structure medial to it and reconstruction of OAC with conchal cartilage. Complete disease removal with soft wall reconstruction is a viable method for OACC.
Keywords: Cholesteatoma, conchal cartilage, outer auditory canal
|How to cite this article:|
Verma H, Dass A, Singhal SK, Gupta N. Outer auditory canal cholesteatoma. Int J Health Allied Sci 2017;6:230-2
| Introduction|| |
Outer auditory canal cholesteatoma (OACC) is the rare form of cholesteatoma of temporal bone and it accounts 0.1%–0.5% of new patients at clinics of otolaryngologist. This condition affects especially elderly people. The disease is slowly progressive, and patient may be symptom-free. So that it diagnoses late and with progressive bone destruction, affecting important circumjacent structures.,, We are presenting here rare case of OACC in which excision was done by canal wall down mastoidectomy and reconstruction of OAC with conchal cartilage.
| Case Report|| |
A 55-year-old male patient presented with a 5-year history of decreased hearing from the left ear. The hearing loss was progressive in nature. There was no other associated history. On examination, the bony part of canal was narrowed by cystic swelling (<1 cm diameter) in posterosuperior part, and it was filling <½ of canal. The swelling was smooth surface and soft in consistency. The part of tympanic membrane visible on otoscopy was normal. Fine-needle aspiration showed yellow color fluid with neutrophil-predominant inflammatory cells in it. High-resolution computed tomography temporal bone showed homogeneous soft tissue density in the left OAC with erosion of posterior canal wall and extension of mass in mastoid air cells [Figure 1]. Attic and mesotympanum are normal with normally ossicular chain. Pure tone audiometry showed AB gap of 30 dB, and it was conductive hearing loss. The canal malignancy and cholesteatoma were kept as differential diagnosis as the disease was unilateral in advance age without comorbidities. After informed consent, the patient was planned for exploration by postauricular approach under general anesthesia. Examination under microscope showed pale color cystic mass, and on palpation, the outer part of bony canal was eroded. The tympanic membrane was completely normal with normal adjoining canal wall. The disease was extending in lateral part mastoid cavity directly by erosion of canal wall. After disease excision tunnel was created in remaining part of posterior canal wall to fit conchal cartilage [Figure 2]. Conchal cartilage was harvested from the left pinna. The postoperative period was uneventful, and patient gained 15 dB hearing in the follow-up period. The final pure tone audiometery was 20/35 dB and no postoperative radiology was performed. The histopathology report reviling feature of squamous epithelium-lined matrix with granulation in perimatrix suggestive of cholesteatoma [Figure 3].
|Figure 1: High-resolution computed tomography temporal bone showing soft tissue density in outer auditory canal with erosion of posterior canal wall and extension into mastoid cavity|
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|Figure 2: Conchal cartilage used for reconstruction of outer auditory canal with intact tympanic membrane of the left ear|
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|Figure 3: Histopathological picture reviling feature of squamous epithelium lined matrix with granulation in perimatrix suggestive of cholesteatoma|
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| Discussion|| |
Toynbee was described first and coined term “epidermal sheets” for cholesteatoma originates from the external auditory canal. Cholesteatoma can be congenital or acquired, and it is most commonly found in the middle ear cleft (98%). OACC is acquired, and it is a rare entity. A cholesteatoma is a sac-like structure which is lined by stratified squamous keratinizing epithelium with associated inflammation and erosion of temporal bone.
Principle etiological factor for OACC is not clear. It may occur spontaneous or after accidental or surgical trauma of OAC. Natural removal of keratin debris in outer ear is by normal outward migration of epithelium from tympanic membrane and OAC. The loss and reduced rate of self-cleaning property of EAC may be responsible for spontaneous OACC. Patients may present with a history of otorrhea, dull pain, hearing loss, etc., The enzymatic proteolysis, pressure effect of accumulated keratin debris and superadded bacterial infection is thought to be the cause of bony erosion in OACC. The differential diagnosis for OACC is keratosis obturans, postinflammatory medial canal fibrosis, malignant otitis externa, and squamous cell carcinoma. The history and physical examination are the basis of diagnosis and CT is done to the known extent of disease. The presence of soft-tissue mass with bony fragments and bony erosion is the CT presentation of an OACC.
The treatment options may be conservative or surgical. In patients where lesion is completely visualized and in patient with no chronic pain, treatment is conservative in the form of frequent cleaning and local wound debridement. Surgical treatment is indicated in patients with persistent chronic pain despite medical management, frequent infection, in complicated ear, progression during follow-up, and in immunocompromised., Extension of disease in mastoid air cells, modified radical mastoidectomy may be indicated, with the tympanic membrane and ossicles left intact as we did in our case. Various methods mentioned in literature to reconstruct OAC whereas we choose conchal cartilage.,,,
| Conclusion|| |
Canal wall down mastoidectomy with reconstruction with cartilage is effective choice to evade cavity problem.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]