ArticlePDF Available

Posttraumatic Cholesteatoma Complicated by a Facial Paralysis: A Case Report

Wiley
Case Reports in Otolaryngology
Authors:
Mehdi Chihani
Mehdi Chihani
Abdelfattah Aljalil at avicenna military hospital, morocco, marrakech
Abdelfattah Aljalil
  • avicenna military hospital, morocco, marrakech
Mohamed Mliha Touati at avicenne military hospital
Mohamed Mliha Touati
  • avicenne military hospital
Brahim Bouaity
Brahim Bouaity
Show all 5 authorsHide
Download full-text PDFDownload full-text PDF
Read full-text
Download citation

Abstract and Figures

The posttraumatic cholesteatoma is a rare complication of different types of the temporal bone damage. Its diagnosis is often done after several years of evolution, sometimes even at the stage of complications. A case of posttraumatic cholesteatoma is presented that was revealed by a facial nerve paralysis 23 years after a crash of the external auditory canal underlining the importance of the otoscopic and radiological regular monitoring of the patients with a traumatism of the temporal bone.
Figures - uploaded by Brahim Bouaity
Author content
All figure content in this area was uploaded by Brahim Bouaity
Content may be subject to copyright.
55b95c5508ae092e965b32
ef.pdf
Content uploaded by Brahim Bouaity
Author content
All content in this area was uploaded by Brahim Bouaity on Jul 29, 2015
Content may be subject to copyright.
Posttraumatic Cholesteatoma Complicated by a Facial Paralysis: A Case Repo
rt.pdf
Available via license: CC BY 3.0
Content may be subject to copyright.
A preview of the PDF is not available
... In contrast to sporadic case reports on FN motor function impairment [9][10][11][12][13], we identified only a single report on CTN damage by EACC [14] in the MEDLINE. Moreover, we could not locate any systematic study about the relevance of CTN involvement and taste dysfunction caused by EACC. ...
... Sporadic case reports document acute taste alteration as a sign of CTN damage from EACC [14], middle ear cholestatoma [48], EAC lesion [49], or atypical KO [50]. Regarding EACC, however, reports of FN invasion predominate [9][10][11][12][13]. Although our data were limited by the retrospective nature of our study and the rarity of the disease, they illustrate that 12 of 73 EACC patients showed either subjective or objective taste dysfunction. ...
Taste Alteration in External Auditory Canal Cholesteatoma: Indicator of Impending N VII Affection
Article
  • Jan 2023
Introduction: External auditory canal cholesteatoma (EACC) is a rare disease, with an estimated incidence of approximately 1:1,000 adult and 1.6:1,000 pediatric otologic patients. Systematic studies of chronic ear disease and taste alteration prior to surgery are rare; in fact, there are no such studies for EACCs. Therefore, we describe chorda tympani nerve (CTN) dysfunction and the related clinical consequences in EACC patients. Methods/study design: Between 1992 and 2021, we retrospectively analyzed the symptoms, signs, and radiological and intraoperative descriptions of CTN involvement in 73 patients. Liquid taste tests and, since 2009, Taste StripsTM as well as an olfactory screening test (Smell DiskettesTM) have been performed for all symptomatic patients and, when feasible, all other EACC patients. Results: Ten of 73 patients complained subjectively of dysfunction, and 8 showed abnormal taste test results. Four patients complained of olfactory dysfunction (3 cases with pathological taste tests). Gustatory dysfunction was most frequent in radiogenic EACC cases (n = 4), followed by postoperative EACC (n = 3). Two postoperative patients were asymptomatic despite abnormal test results. Rarely, patients with idiopathic (n = 2) and posttraumatic (n = 1) EACC showed acute taste dysfunction that was confirmed in each with abnormal test results. Discussion/conclusion: CTN dysfunction often developed asymptomatically in chronic ears, except for idiopathic and posttraumatic EACCs under previous healthy middle ear conditions. Taste disturbance is not a cardinal symptom of EACC, but objective testing suggests that up to one out of 10 EACC patients with advanced disease may experience regional gustatory dysfunction prior to surgery. Especially in context of a new and acute presentation, regional taste dysfunction may alert the clinician of potential progressive EACC invasion and danger to the facial nerve.
View
... and cholesteatoma, an important learning point from this case is that post-traumatic cholesteatoma may represent an uncommon and late complication of temporal bone trauma. Even if it occurs many years after the initial injury, the mechanism of implosive skin intrusion may cause typical cholesteatoma-related complications, such as a brain abscess and need for extensive otologic surgery to address the underlying issue [6]. Due to this possible link, the importance of a timely diagnostic workup, including radiologic imaging in patients with significant temporal bone trauma is paramount. ...
View
... and cholesteatoma, an important learning point from this case is that post-traumatic cholesteatoma may represent an uncommon and late complication of temporal bone trauma. Even if it occurs many years after the initial injury, the mechanism of implosive skin intrusion may cause typical cholesteatoma-related complications, such as a brain abscess and need for extensive otologic surgery to address the underlying issue [6]. Due to this possible link, the importance of a timely diagnostic workup, including radiologic imaging in patients with significant temporal bone trauma is paramount. ...
View
... However, potentially disastrous complications, such as malignant otitis externa, meningitis or brain abscess, may occur and resulted in death. [7][8][9][10][11][12] We report a nasopharyngeal carcinoma case with osteoradionecrosis and cholesteatoma of the external auditory canal after external-beam radiotherapy treatment in a woman who had experienced this complication 2 years after she had undergone 32 nd times radiotherapy. Her condition resolved after removal of crust from the external auditory canal, followed by antibiotic therapy and periodic aural toilet with local anasthesia. ...
Osteoradionecrosis and cholesteatoma of external auditory canal in postradiotherapy nasopharyngeal carcinoma patien
Article
  • Nov 2013
Background: Osteoradionecrosis and cholesteatoma of the external auditory canal following external-beam radiotherapy as the treatment of nasopharyngeal carcinoma is a rarely found complication. Patients with external auditory canal cholesteatoma (EACC) typically present with chronic otorrhea and dull pain due to the local invasion of squamous tissue into the bony external audioty canal (EAC). Purpose: To remind ENT specialists and general practitioners about the risk osteoradionecrosis and cholesteatoma of external auditory canal in nasopharyngeal carcinoma patient after radioteraphy treatment. Case: We report a case of osteoradionecrosis andcholesteatoma of EAC in nasopharyngeal carcinoma (NPC) patient with complaint of a foul-smelling discharge from her right and left ears. Two years previously she had undergone external-beam radiotherapy to the neck as the treatment for nasopharyngeal carcinoma. Management: The cholesteatoma was removed microscopicaly on local anasthesia. After the cholesteatoma had been removed the right ear result of pure tone audiometry showed mild degree conductive hearing loss (27,7 dB), while the left ear within normal hearing threshold. Conclusion: Osteoradionecrosis and cholesteatoma of external auditory canal could develop as a complication ofradioteraphy in nasopharyngeal carcinoma patient. Keywords: osteoradionecrosis, cholesteatoma, radiotherapy, chronic otorrhea.ABSTRAKLatar belakang: Komplikasi osteoradionekrosis dan kolesteatoma pada liang telinga luar akibat radioterapi pada pengobatan karsinoma nasofaring sangat jarang terjadi. Pasien dengan kolesteatoma liang telinga luar biasanya datang dengan keluhan otore kronis dan nyeri akibat invasi dari jaringan skuamus ke tulang liang telinga luar. Tujuan: Memberi wawasan bagi dokter umum dan spesialis THT-KL tentang adanya risiko osteoradionekrosis dan kolesteatoma pada liang telinga luar akibat radioterapi pada penderita karsinoma nasofaring. Kasus: Dilaporkan satu kasus osteoradionekrosis dan kolesteatoma di liang telinga luar pada penderita karsinoma nasofaring dengan keluhan sekret telinga berbau busuk pada liang telinga kanan dan kiri.Dua tahun sebelumnya pasien tersebut mendapat radioterapi untuk pengobatan karsinoma nasofaring. Penatalaksanaan: Kolesteatoma diangkat secara mikroskopis dengan anestesi lokal. Pemeriksaan audiometri nada murni pascatindakan didapati tuli konduktif derajat ringan (27,7dB) pada telinga kanan sedangkan telinga kiri dalam batas normal. Kesimpulan: Radionekrosis dan kolestatoma liang telinga luar merupakan komplikasi terapi radiasi pada kasus karsinoma nasofaring.Kata kunci: osteoradionekrosis, kolesteatom, radioterapi, otore kronis.
View
The effects of insulin on the volume, absolute and relative weight of liver in hfd/streptozocin induced diabetic rats
Article
  • May 2014
Objectives: In present study, the effects of insulin on the volume, absolute and relative weight of liver was studied in Wistar albino rats for a period of 4 weeks. Study Design: Retrospective / observational study. Place and duration of study: This study was conducted in the Animal House of DUHS and it took 8 months 1st June 2011 to 1st Feb 2012 to be completed. Materials and Methods: The Male Wistar albino rats which were randomized into 3 groups; each group containing 10 rats. Group A served as control, Group B as insulin treated and Group E as untreated diabetic rats. All the other rats except the Group A were kept on in-house prepared High Fat Diet (HFD) throughout the study. After 2 weeks of exclusive HFD, diabetes was induced by intraperitoneal (IP) injection of low dose streptozocin (STZ 3.5mg/100gm). After the induction, one group was left untreated (Group E) and one group (Group B) was treated with insulin for 4 weeks. The rats were then, sacrificed, liver was isolated, weighed, and its dimensions were noted. Results: The mean absolute liver weight (ALW) of rats was observed as 8.60 ± 2.54 gm, 13.18 ± 0.68 gm and 9.40 ± 3.18.gm in control, untreated and insulin treated groups respectively. And the mean percent liver weight (PLW) was calculated as 2.99 ± 0.66%, 5.10 ± 0.73% and 3.99 ± 1.37% in control, untreated and insulin treated groups respectively. Statistically significant difference was noted between ALW, PLW and liver volume of rats of the three groups. Conclusion: Insulin decreases the volume, absolute and relative weight of liver of diabetic rats when used for a short period.
View
Post-traumatic cholesteatoma... a rare occurrence
Article
Full-text available
  • Aug 2008
Temporal bone fractures and their acute complications have been well described in radiology and ENT journals. This is in contrast to the delayed and rare complication of implantation cholesteatomas. We present the CT findings of two cases of infiltrating cholesteatomas that developed many years following temporal bone trauma.
View
Magnetic Resonance imaging of cholesteatoma: an update
Data
Full-text available
  • Jan 2009
Magnetic resonance imaging of cholesteatoma: an update. Objective: To report on the value and limitations of new MRI techniques in pre- and post-operative MRI of cholesteatoma. The current value of magnetic resonance imaging (MRI) in diagnosing congenital, acquired, and post-operative recurrent or residual cholesteatoma is described. Methodology and results: High resolution computed tomography (HRCT) is still considered the imaging modality of choice for detecting acquired or congenital middle ear cholesteatoma. However, MRI may provide additional information on the delineation and extension of cholesteatoma and on potential complications. Detecting post-operative residual or recurrent cholesteatoma with HRCT was shown to be inaccurate due to the technique's low sensitivity and specificity. Conclusions: Recently, improvements in MRI techniques have led to a more accurate diagnoses of cholesteatoma using delayed contrast enhanced T1-weighted imaging and diffusion-weighted imaging.
View
Magnetic resonance imaging of cholesteatoma: An update
Article
Full-text available
  • Dec 2009
To report on the value and limitations of new MRI techniques in pre- and post-operative MRI of cholesteatoma. The current value of magnetic resonance imaging (MRI) in diagnosing congenital, acquired, and post-operative recurrent or residual cholesteatoma is described. High resolution computed tomography (HRCT) is still considered the imaging modality of choice for detecting acquired or congenital middle ear cholesteatoma. However, MRI may provide additional information on the delineation and extension of cholesteatoma and on potential complications. Detecting post-operative residual or recurrent cholesteatoma with HRCT was shown to be inaccurate due to the technique's low sensitivity and specificity. Recently, improvements in MRI techniques have led to a more accurate diagnoses of cholesteatoma using delayed contrast enhanced T1-weighted imaging and diffusion-weighted imaging.
View
Computed tomography of secondary choleastoma of the inner ear
Article
  • Feb 2000
  • FEUILL RADIOL
Cholesteatoma is an aggressive form of otitis media with keratine accumulation and bone erosion. Although diagnosis is based in most cases upon otoscopic examination, CT scan is a valuable technique for preoperative determination of the topographic extension of the disease, and for the detection of local complications and hazardous anatomical variants. In some instances, the diagnosis may be assessed on CT findings when clinical examination is unconclusive or impossible. Conversely, CT does not allow a reliable detection of postoperative recurrences of cholesteatoma.
View
Cholestéatome de l’oreille moyenne
Article
  • Jun 2006
Le cholestéatome de l’oreille moyenne est une forme particulièrement agressive d’otite moyenne chronique. Le but de cet article est de présenter une mise au point sur la prise en charge de cette pathologie, en intégrant les données récentes de la littérature et l’expérience des auteurs issus de deux Écoles d’otologie françaises (Professeur Pierre Roulleau à Paris et Professeur Robert Charachon à Grenoble). Les principales avancées récentes sont représentées par la généralisation de l’utilisation du cartilage comme matériau de reconstruction du cadre et de la membrane tympanique (permettant une réduction significative du taux de récidive cholestéatomateuse) et par les progrès de l’imagerie qui permet de mieux cerner les extensions du cholestéatome en pré-opératoire (autorisant ainsi à choisir la technique chirurgicale la plus adaptée à chaque cas) et qui permet également un suivi moins invasif en post-opératoire.
View
Imagerie des otites chroniques de l’adulte
Article
  • Nov 2006
  • J RADIOL
Chronic otitis media (COM) can be divided into two subtypes: COM with cholesteatoma (including precholesteatomatous states) is an aggressive form of otitis. Surgical treatment is mandatory because of the risk for labyrinthine or cerebromeningeal complications. CT is very important in the preoperative work-up (extension of cholesteatoma, anatomic variants). In patients who have undergone middle ear surgery, CT and presently MRI play an increasing role in the detection of recurrent or relapsing cholesteatoma.COM without cholesteatoma does not have an osteolytic potential, but may leave auditive sequelae that in selected cases may warrant surgical treatment to improve hearing. CT is useful in the etiological work-up of patients with severe hypoacusis. CT also plays an important role in cases of surgical failure, to detect a dislocation of the ossiculoplasty or impairment of the middle ear caused by fluid effusion.The objective of this paper is to specify the indications, the results and the limits of pre- and postoperative imaging in COM.
View
Surgical management of cholesteatoma: The two main options and the third way - atticotomy/limited mastoidectomy
Article
  • Jul 2009
Chronic otitis media with cholesteatoma is considered an "unsafe" ear and generally requires surgical management. This is particularly challenging in children due to anatomical, pathophysiological and social reasons. There are different approaches for this objective. The two main options are the canal wall up and canal wall down mastoidectomy. The aim of this article is to compare the advantages and disadvantages of canal wall up and canal wall down method and present the third way of surgical management: the inside-outside approach through an endaural incision. This technique includes atticotomy, atticoantrostomy or mastoidectomy (mostly very limited) according to the size and location of the cholesteatoma. This technique contributes to the successful surgical management of cholesteatoma, eradicating the disease with the creation of small, dry, self-cleaning cavities and no pinna protrusion. Moreover, there is no need for meatoplasty or obliteration. However, we should never forget that in ear surgery the choice of the operative procedure should take into account the needs of the patient, the extent of the disease, and the surgeon's experience.
View
[Cholesteatoma of the ear]
Article
  • Mar 1989
Cholesteatoma of the ear is characterized by the presence of a keratinizing squamous epithelium in the cavities of the middle ear. The epithelium invades the ear either by direct migration or by retraction of the eardrum. Owing to is potentials for migration, desquamation, bone erosion and infection, it is for most of the complications of chronic otitis and fully justifies the adjective "dangerous" applied to chronic cholesteatomatous otitis. The clinical diagnosis rests on microscope otoscopy. Audiometry informs on the degree of hearing loss and on the state of the contralateral ear. Standard radiography and computerized tomography of the petrous bone evaluate the extent of the lesion. Treatment is purely surgical: it consists of excision of the entire epithelium that has entered the middle ear and, secondarily, conservation or improvement of hearing. Whatever the surgical technique used, the frequency of recurrences calls for long-term follow-up.
View
Post-Traumatic Cholesteatoma
Article
  • Sep 1989
Cholesteatoma can develop as a late complication of fracture of the temporal bone. The otologist must be wary of it since the growth of the cholesteatoma resulting from a temporal bone fracture can be undetected for years allowing for invasive and extensive growth. Three illustrative cases are presented.
View
Post-Traumatic Cholesteatoma
Article
  • Mar 1983
Post-traumatic cholesteatoma is a rare condition which has received scant attention in the English language literature. Three cases of different aetiology arising in the tympanomastoid region and in the external auditory canal are described, and the pathogenesis of the various types of traumatic cholesteatoma discussed. The important medico-legal implications of this clinical entity are stressed, and the necessary requirements to establish a causal correlation outlined.
View