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Transoperative picture of modified radical mastoidectomy showing intact TM and CEAC affecting the mastoid.
Source publication
The authors present a case of cholesteatoma of external auditory canal (CEAC) with extensive invasion of mastoid; ossicle chain and tympanic membrane remained intact. The only symptom was chronic otorrhea. Diagnosis was based on clinical elements and CT scan was used to measure pathology and program surgery. Treatment was modified radical mastoidec...
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Citations
... The two main suggested that: firstly, the EAC cholesteatoma is due to [1,6]. CT of the temporal bones is the gold standard to assess the severity and the extent of the disease [1,6,7]. CT imaging shows a soft-tissue mass with adjacent bone erosion. ...
... Treatment may be conservative or surgical [3][4][5][6]. The [4][5][6][7]. Concerning our patient, the lesion was limited to the tympanal bone. However, we decided a surgical approach, because in our context, follow-up of patients is difficult. ...
Cholesteatoma is a common occurrence in the middle ear. Cholesteatoma of the external auditory canal (EAC) is a rare entity. We report the first case of our department of cholesteatoma of the EAC limited to the posterior wall, in a 14-year-old patient presented with chronic left purulent otorrhea. We performed a canalplasty under general anesthesia. Debris of keratin were removed and the eroded bone was curetted. We repaired the bony erosion with the tragal cartilage. Two years after the surgical procedure, there was no evidence of recurrence. Clinical symptoms of EAC cholesteatoma are not specific. It is therefore important to think about cholesteatoma when a patient presents with chronic otorrhea with intact tympanic membrane.
... Thus, the diagnosis is eminently clinical. When examining otoscopy, the tympanic membrane is intact in most cases with erosion restricted to one point of EAC [7]. Hearing is usually preserved.6 ...
... Most studies show that minor lesions can be treated conservatively or by minor procedures under local anesthesia, whereas larger lesions require a surgical procedure to remove the cholesteatoma [2]. The following surgical indications are considered: chronic pain (despite clinical treatment); constant infection (due to the possibility of developing bacterial resistance); the onset of facial paralysis or chronic vertigo; progression of the lesion during follow-up; CT showing involvement of the hypotympanum, jugular dome or mastoid; Diabetes Mellitus or immunosuppression (predisposition to necrotizing otitis externa) [7]. ...
... The EACC is a rare condition that presents with insidious symptoms, while the extent of bone destruction progresses. In the presented case the lesion was extensive at the time of its diagnosis, compatible with the majority of cases in the literature, diagnosed late [2,7,9]. ...
... Schofield introduced the term external auditory canal cholesteatomain 1893 in describing a cholesteatoma that had been caused by an insect [1].In 1854; Toynbee was the first author to describe that cholesteatoma originates from external auditory canal as epidermal sheets. Till 1980, cholesteatoma external auditory canal and keratosis obturans were considered as different presentation of the same disease [2]. Piepergerdes described cholesteatoma of the external auditory canal and keratosis obturans as two different pathological processes; keratosis obturans as keratin accumulation in the external auditory canal; and external auditory canal cholesteatoma as bone erosion resulting from squamous tissue on a specific spot of the external auditory canal [3]. ...
... The exact etiology of external auditory canal cholesteatoma is unclear [4,5].Cholesteatoma of the external auditory canal is very uncommon, as it is seen in only 0.1 to 0.5% of patients who present with an otologic disorder [2,5,6].The cholesteatoma of the external auditory canal may arise through several mechanisms. Occlusion or narrowing of the external auditory canal is the basic cause [7].Most cases occur spontaneously or after surgery (tympanoplasty, middle ear surgery, or mastoid surgery) and/or trauma in the auditory canal; preexisting ear canal stenosis or obstruction has also been described as a causative factor [8,9]. ...
... The reported complications of an external auditory canal cholesteatoma include facial palsy, ossicle erosion, and labyrinthine fistula [11] These complications can occur as a result of an extensive cholesteatoma extending to the mastoid or the middle ear [9] Extensive invasion in to the mastoid cavity has a propensity to involve the vertical segment of the facial nerve [2,7,12,13]. Those external auditory canal cholesteatomas that occur as a complication of surgery or trauma are more likely than other forms to violate the middle ear cavity, and they commonly require surgical treatment [13]. ...
Cholesteatoma of the external auditory canal is very uncommon. Most cases occur spontaneously or after surgery (tympanoplasty, middle ear surgery, or mastoid surgery) and/or trauma in the auditory canal. Previous tympanoplasty is one of several known predisposing factors for external auditory canal cholesteatoma. In this article, the author reports 36 cases of external auditory canal cholesteatoma that occurred following a tympanoplasty. The mass was excised, and it was diagnosed on histopathology.
... Both conditions are considered uncommon, with cholesteatoma of the external auditory canal quoted as 0.1-0.5% of patients with otologic disorder [7][8][9]. Several classifications have been proposed for external auditory canal cholesteatoma [10,11] none was available for keratosis obturans. Further, no incidence or prevalence figures are available for keratosis obturans despite extensive search, further emphasising its rarity of occurrence. ...
... Many hypotheses have been propounded but none has satisfactorily been able to explain the contributing factors, nor the actual aetiology of the disease; these included risk factors associated with sinusitis and bronchiectasis [2], faulty migration of the squamous epithelial cells from the tympanic membrane and adjacent canal wall [4,[7][8][9], etc. Inflammation caused by virus, fungus and parasite have been proposed as the cause which led to initiation of the disease process. There is also much confusion between whether KO and external canal cholesteatoma are two different entities, or one entity but at opposite ends of the disease spectrum [4][5][6]. ...
Keratosis obturans appears to be an obscure and relatively uncommon entity, even in literature search of journals and reference texts, so much so that there is not even any prevalence or incidence statistics available. However, the condition did not appear to be as uncommon based on our clinical observations. We have managed to obtain 64 patients representing 67 ears with keratosis obturans in our study period of about 18 months with a pattern of occurrence during this period. Humid weather seemed to play a role in the frequency of its appearance during certain period in our observation. There also appears to be a correlation between the severity of symptoms (predominantly pain and hearing loss) and the presenting appearance of the condition, i.e., presence or absence of granulation tissue, as well as that the degree of difficulty in exenteration of the keratosis obturans (matrix and content) depending on the expansion of the bony canal. Our figures showed the majority of the patients are females and young individuals, the majority of them occur unilaterally. The condition also appear to stop short of involving the tympanic membrane with only the bony canal being expanded with the surrounding oedema creating an apparent “canal stenosis”.
... So that it diagnoses late and with progressive bone destruction, affecting important circumjacent structures. [2][3][4] 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. ...
... Audiometric state is usually variable; it can be found from normal hearing to moderate conductive hearing loss [11]. Histopathological studies confirm the presence of periostitis located in the eroded area, periosteitis and bone sequestrums, and granulation tissue. ...
... For localized lesions, treatment consists on debridement of necrotic tissue and keratin. In larger defects, a mastoidectomy and reconstruction of the EAC should be considered [1,11]. Surgical criteria include chronic pain, recurrent infections with resistant strains despite proper cleaning and debridement, complications such as facial palsy or the presence of vertigo [3,6]. ...
... Ohhashi et al [11] reported that extracanalicular osteomas of the temporal bone occur twice as often in females and that EAC osteomas occur twice as often in males. Cholesteatomas of the external auditory canal is uncommon, observed in 0.1-0.5% of patients who come with an otologic disorder [12,13,14]. External auditory canal osteoma is also a rare entity with an estimated incidence of of 0.05% of total otologic surgery [9]. ...
... External auditory canal osteoma is also a rare entity with an estimated incidence of of 0.05% of total otologic surgery [9]. The association that we are presenting here between an osteoma and cholesteatoma is extremely rare with only a few reported cases in literature [3,12,14,15]. ...
Osteomas of temporal bone are rare, slow growing neoplasm. They can occur in all parts of temporal bone, including the bony portion of the external auditory canal (EAC).A complication of osteoma of EAC is ear canal cholesteatoma. Here a male patient aged 37 years presented with history of right ear discharge for 10 years, decreased hearing for 8 years and a spontaneously discharging swelling with sinus in the post auricular region for 15 days. On examination of right ear there was complete obliteration of EAC by a hard bony mass and tympanic membrane was not visualised. The swelling in the post auricular region was fluctuant with mucopurulent discharge. Facial nerve examination was normal. Tuning fork tests showed conductive hearing loss in the right ear. Computerised axial tomography of temporal bone showed a solitary osteoma which was pedunculated arising from posterior wall of right EAC with a soft tissue mass filling the medial part of EAC and middle ear. A diagnosis of Osteoma of EAC with cholesteatoma was made and was posted for surgery. Modified radical mastoidectomy and tympanoplasty was done with complete excision of EAC osteoma and cholesteatoma.
... If the cholesteatoma invades into the mastoid, it may erode the facial nerve canal, sigmoid sinus and semicircular canals. 2,7,[11][12][13][14][15][16][17] Erosion through the anterior wall of the canal may affect the temporomandibular joint. 2,13,18 Rarely, in advanced cases, extension into the posterior fossa has been reported, with resulting intracranial abscess. ...
Objectives:
To describe the clinical features of external auditory canal cholesteatoma, and to assess the outcome following bony meatoplasty with tragal cartilage and perichondrium graft repair.
Methods:
A retrospective review was carried out, comprising all patients with external auditory canal who presented between January 2007 and December 2011. Patients underwent pre-operative audiometry and computed tomography imaging of the temporal bones, before undergoing bony meatoplasty via a postauricular incision. Pre- and post-operative comparisons were made of patients’ otological symptoms and the otoscopic appearance of the external ear canal.
Results and conclusion:
Eight patients were included in the analyses. The median age of patients was 46.5 years (range 14–68 years), with a male to female ratio of 1:1. The median length of follow up was 16 months. The most common presenting features were unilateral otalgia and purulent otorrhoea. All patients had relatively advanced disease at presentation, with erosion of the temporal bone. All patients underwent bony meatoplasty via a postauricular approach to eradicate the disease. Bony meatoplasty was successful in the definitive management of external ear canal cholesteatoma.
... The differential diagnosis includes keratosis obturans, necrotizing external otitis, and tumors. [15] The management of EACC is debatable in terms of surgery versus conservative treatment. It has been recommended that all patients should undergo surgical removal of the cholesteatoma and necrotic bone to prevent progression and continued erosion. ...
... [1] Surgical treatment is recommended for EACC, especially in cases of chronic pain constant infection and complications (hypoacusis, facial paralysis, chronic vertigo, lesion progression, hypotympanum involvement, jugular foramen or mastoid involvement). [15] When the mastoid air cells are invaded, a modified radical mastoidectomy may be indicated, with the tympanic membrane and ossicles left intact. [7] conclusIon EACC may presents as an insidious entity concealing serious destruction with few or no symptoms. ...
External auditory canal cholesteatoma (EACC) is an uncommon disease and its pathogenesis remains unclear. Clinically, patients usually present with symptoms like chronic dull pain and otorrhea, but many patients can be astonishingly silent or even asymptomatic. The intracranial complication with extensive mastoid cavity from primary EACC is extremely rare. Early diagnosis is imperative to facilitate best possible intervention and to relieve patient symptoms and to prevent further complications. We present the first report in the English literature of a case of primary EACC presenting as cerebellar abscess. We experienced a rare case of a 55-year-old female patient admitted in our hospital with cerebellar abscess complicated by a cholesteatoma in the external auditory canal. The patient was first managed conservatively with systemic antibiotics by neurosurgeon, and then the disease was removed successfully by canal wall down mastoidectomy and no recurrence had occurred in the first 4 months post-operatively.
... This is how the idea came about that this was primarily bone involvement that could be caused by infection or ischaemia leading to necrosis and reactive periostitis or the reverse. The excessively desquamated appearance of the epithelium due to blocked lateral epithelial migration, a phenomenon specific to the epidermis of the bony portion of the EAC, was in this case thought to be triggered by an inflammatory process, whether this originated locally to the canal or in an adjacent structure [1,3,[6][7][8]. In terms of anatomical pathology investigations, a study of cholesteatoma of the EAC confirms the presence of periostitis restricted to the eroded area, as well as osteitis, bone sequestra, and reactive inflammatory tissue. Epidermal cells are found in the excavated portion surrounding bone sequestra. ...
... Cross-sectional imaging modalities and especially computed tomography are very useful for positive diagnosis, since this approach can pinpoint the localisation of the cholesteatoma and accurately assess the lesion, in particular bone involvement and depth of spread [2][3][4]8,10,11]. ...
... Firstly, the entity defined as spontaneous cholesteatoma must be dissociated from any secondary cholesteamatous lesions, such as: accumulations of keratin in the canal resulting from congenital or acquired stenosis (due to trauma or surgery), epidermal cysts beneath the skin of the canal found some time after surgery to the middle ear, epidermal invasions secondary to a fracture of the tympanic bone, and the very rare congenital epidermal cysts to the posterior canal wall [3,10]. A localised form of osteoradionecrosis of the tympanal bone can also produce a very similar clinical picture of bone erosion, sequestra, granulation tissue, and keratin accumulation, so is essential to look for a history of head and neck irradiation in this situation [7,8,10]. Necrotising otitis externa can be identified by its specific predisposing factors (it mainly develops in elderly and diabetic patients) and on examination of the EAC, which shows the canal to be inflamed and with a least some degree of stenosis as well as granulation tissue being present at the junction of the bony and cartilaginous portions of the EAC. ...
Spontaneous external auditory canal (EAC) cholesteatoma is a rare disease. The symptoms are nonspecific. It is diagnosed by clinical examination and radiological investigation. The clinical examination alone is often insufficient for accurately assessing spread of the cholesteatoma into the temporal bone, meaning cross-sectional imaging modalities are required, and specifically computed tomography. We report three cases of spontaneous cholesteatoma of the external auditory canal. All of our patients underwent surgery. In two cases, the cholesteatoma was restricted to the external auditory canal, while in one case, it was complicated by a fistula with the lateral semicircular canal. Good anatomical and functional results were obtained in all three cases, with the external auditory canal patent and a good calibre on completion.
