Figure - available from: European Archives of Oto-Rhino-Laryngology
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a, b Coronal and axial CT of two Stage IIIC patients. Arrows show that lesions can invade toward different directions of the EAC and the circle shows the involvement of the facial nerve. c, d Axial and coronal CT of a patient with Stage IV lesions. Circumferential invasion of the EACC involves the dura (c, arrow) and the patient also has headache, thus classifying the lesion as Stage IV; the circle c demonstrates the destruction of the facial nerve canal; the air-containing space (d, arrow) demonstrates outward-to-inward extension of the lesion, implying that the cholesteatoma originated from the EAC rather than the middle ear
Source publication
Purpose
Limited literature exists on primary external auditory canal (EAC) cholesteatoma (EACC). Here, we focus on the clinical features of this rare disease, especially the invasive patterns of lesion progression, through a large population study and present simple and practical staging.
Methods
In all, 276 patients (male 99; female 177; mean age...
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Patient: Male, 52-year-old
Final Diagnosis: Superior semicircular canal dehiscence • tegmen tympani dehiscence
Symptoms: Dizziness • hearing loss • vertigo • vomiting
Clinical Procedure: —
Specialty: Radiology
Objective
Rare disease
Background
Superior semicircular canal dehiscence is an inner-ear pathology which presents with vertigo, disequilib...
Citations
... Cholesteatoma of the external ear canal, another rare pathology, presents first with hearing loss that is then followed by symptoms of otalgia, otorrhea, tinnitus, pruritus, facial paralysis and headache [9]. Location of cholesteatoma was variable, with the inferior wall being the most common site though multi wall involvement was found to be the most common in one study. ...
... Location of cholesteatoma was variable, with the inferior wall being the most common site though multi wall involvement was found to be the most common in one study. Invasion patterns also were variant and can invade temporal bone, mastoid bone and air cells, as well as the tympanic membrane [9]. ...
... When compared to benign osteonecrosis of the external ear, the malignant pathology is usually associated with a bacterial infection, immunosuppression and diabetes. There are five diagnostic criteria for malignant otitis externa including persistent external otitis, granulation tissue, radiographic confirmation of osteomyelitis, cranial involvement and isolation of P. aeruginosa from ear drainage and three of these signs must be met in order to diagnose [9,10]. There are no such diagnostic guidelines for benign osteonecrosis, which presents with the clinical presentation of ear fullness, decreased hearing, pain or tinnitus [3]. ...
Benign osteonecrosis of the external ear canal is a rare pathology that commonly gets misdiagnosed as cholesteatoma of the external ear canal, keratosis obturans and malignant otitis externa. Each pathology has characteristics that allow for differentiation between them. Careful analysis is required to diagnose properly and determine the best modality of management. This case series presents two patients that were diagnosed with benign osteonecrosis of the external ear canal and is being managed conservatively with serial debridement. Response to conservative treatment has resulted in adequate control of symptoms in both patients.
... Recently, He et al. (2022) provided CT images of EACC cases that can be compared with our CT findings. Based on this comparison, Case 2 is considered to represent stage III of their classification that is characterized by "invasion beyond the EAC, involving the mastois air cells or tympanic cavity, but confined within the temporal bone" (tab. 1 in He et al., 2022). ...
... Recently, He et al. (2022) provided CT images of EACC cases that can be compared with our CT findings. Based on this comparison, Case 2 is considered to represent stage III of their classification that is characterized by "invasion beyond the EAC, involving the mastois air cells or tympanic cavity, but confined within the temporal bone" (tab. 1 in He et al., 2022). ...
Abnormal loss of bone in the external auditory canal (EAC) constitutes an underreported condition in paleopathology. Thus far, all reported cases were diagnosed as the result of an external ear canal cholesteatoma (EACC). Here we report two cases from the medieval period in Germany that show enlarged EACs with perforations of the anterior and posterior EAC walls. The cases were studied macroscopically, with a digital stereo microscope, and by conventional X‐ray and CT‐imaging techniques. In case 1, the resorption caused a “ballooning” of the EAC while signs of osteonecrosis were missing. We therefore conclude that keratosis obturans (KO) is the most likely diagnosis. In case 2, the periantral region adjacent to the perforations of the posterior EAC wall exhibits large resorption cavities and sequestrum‐like structures, indicative of osteonecrosis. In this case, we arrive at the diagnosis EACC. Ear diseases encompass a broad spectrum of conditions, many of them with potentially severe impacts on past people. It is therefore suggested to address ear diseases more frequently in paleopathology. Thus far only a very limited number of entities of ear diseases have been diagnosed in paleopathological studies, and no case of KO has been reported. The present study thus expands the spectrum of paleo‐otopathological diagnoses.
Ear diseases, especially external auditory canal (EAC) disorders, are rarely reported in paleopathology. This study reports on the archaeological skeletal remains of two adults from the medieval period in China that presented with bony destruction in the external auditory canal (EAC). The observed pathological changes were evaluated macroscopic and microscopic, and micro‐CT (micro‐computed tomography) was used to examine the extent of lesion involvement. The lesions in Case 1 involved the EAC and mastoid process with smooth and regular margins. We, therefore, concluded that EAC cholesteatoma is the most likely diagnosis. In Case 2, the lesion was in the superior and posterior walls of the EAC as well as in the mastoid air cells. In this case, we arrive at the diagnosis of EAC infection. Furthermore, the potential impact of these ear diseases has been discussed. This report addresses the lack of detailed descriptions of EAC diseases in previous paleopathological publications and emphasizes the fact that the diagnosis of ear diseases in this context requires comprehensive observations of lesions as well as of all adjacent structures.
