Petrified ear

Abstract

Petrified ear is an uncommon condition, usually asymptomatic, whether by calcification or ossification, results in a rigid and immalleable ear. In cases of extreme discomfort, surgical intervention like conchal reduction through a posterior incision has been employed.

Full text

ISSN 0971-7749
Vol 17 / Issue 1 / Jan 2011
Indian Journal of Otology
www.indianjotol.org
An Indexed International Journal
Indian Journal of Otology • Volume 17 • Issue 1 • January-March 2011 • Pages 1-***

30 Indian Journal of Otology | January 2011 | Vol 17 | Issue 1 |
CASE REPORT
IntroductIon
Petrification of the auricle, whether by calcification,
ossication, or otherwise, is an uncommon condition, results
in a rigid and immalleable ear. Ectopic calcication represents
an usual cause of a petried ear.[1] It occurs through deposition
of calcium and phosphorus in a proteinaceous matrix as
hydroxyapatite crystals, and by denition it occurs in so
tissue, which does not normally ossify. Radiographically, it
demonstrates the same opacity as thenormal bone, and it is
histologically similar to the lamellar bone found elsewhere
in the body.
case report
A 47-year-old male presented to our OPD with blocking
sensation in both ears for 6 months duration. His other
complaint was mild discomfort during sleeping on sides.
No history of trauma, ear discharge, ear pain, itching, and
tinnitus. e patient could not recall any familial occurrence
of auricular rigidity. Routine ENT examination demonstrated
a bilateral rigidity [Figure 1] of both auricles, which were
completely inexible except of the lobule. e rest of the
auricles configuration and skin appearance were normal
without noticeable cutaneous abnormalities. e external
auditory canal and tympanic membrane were found normal.
Palpation of nasal, thyroid and cricoid cartilages did not reveal
any abnormalities and the epiglottis and arytenoids had a
normal appearance on laryngoscopy. Pure-tone audiogram
reveals a mild degree of sensorineural hearing loss. X-ray
both mastoids, Law’s view revealed opacities [Figure 2]
consistent with the bony structure in the auricle of the ear. e
results of laboratory testings, including complete hemogram,
Petrified ear
P Karthikeyan, A Ganesh Bala, K Priya
Department of ENT, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry, India
biochemistry, serum calcium, and phosphorus levels and
electrolytes were within normal limits. Patient is a known case
of hyperthyroidism and hypertension for past 10–15 years and
on regular treatment.
dIscussIon
e auricle is consisted mainly of the auricular cartilage, a
type of elastic cartilage containing numerous elastic bers.
Except of the auricle, elastic cartilage can be found in the
head and neck region as a basic component of the external
ear canal, nose, and epiglottis and usually does not subject
to calcication or ossication changes. Nevertheless, such
changes rarely can occur in the auricular cartilage and
have been described by various terms such as dystrophic
or metastatic calcification and heterotopic or ectopic
ossication.
[2]
e systemic illness most oen related with calcication of
auricular cartilage is suprarenal insuciency. One of the
aetiological hypotheses posed is that the acute or chronic
shortage of cortisol may produce a long-lasting or transient
hypercalcaemia that favors the deposits of calcium in tissues.
Addison’s disease is the most common endocrinopathy
associated with this condition while hypopituitarism, diabetes
mellitus, acromegaly, and hypothyroidism have also been
reported.
Calcication of the auricular cartilage was rst recognized
as early as 1866 by Bochdalek.[3] Although it seems that
aBstract Petried ear is an uncommon condition, usually asymptomatic, whether by calcication or ossication, results
in a rigid and immalleable ear. In cases of extreme discomfort, surgical intervention like conchal reduction
through a posterior incision has been employed.
keywords: Calcication, Petried ear, Ossication
Address for correspondence: Dr. P. Karthikeyan,
Department of ENT, Mahatma Gandhi Medical College and Research
Institute, Pondy Cuddalore Main Road, Pillayarkuppam,
Puducherry-607 402, India.
E-mail: drkarthik73@yahoo.co.in
Access this article online
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Website:
www.indianjotol.org
DOI:
10.4103/0971-7749.85801

31
Indian Journal of Otology | January 2011 | Vol 17 | Issue 1 |
Karthikeyan, et al.: Petried ear
the disease is infrequently seen in clinical practice, the true
incidence of the condition is a matter of controversy. In 1932,
Scherrer[4] examined 800 apparently healthy patients, aged
between 15 and 75 years and no evidence of calcication was
documented. In 1963, in a randomized study of a series of
300 patients, Gordon[5] examined for inexibility of the ears.
He found radiological evidence of calcication of the ear
cartilage in 11 patients (3%). More recently, in 1998, Bowers
and Gould reported that auricular calcication is found more
frequently in older people, especially those who have worked
outdoors. ese authors concluded that the disease is not, in
fact, rare. Severe hypothermia has been considered as the most
common cause of auricular ossicans. Rapid cooling has been
suggested that can produce vascular thrombosis and occlusion
and consequently the resulting ischemia can induce lamellar
bone proliferation.
Ossication involves new bone development histologically
resembling the trabecular bone. Ectopic ossication[6] of the
auricle (auricular occicans) involves bone formation by the
deposition of calcium and phosphorus in a proteinaceous
matrix as hydroxyapatite crystals in a tissue that normally
does not ossify.
e limited cutaneous form of systemic sclerosis scleroderma
is often referred to as the CREST syndrome. "CREST"[7]
is an acronym for the five main features: calcinosis,
Raynaud's syndrome, esophageal dysmotility, sclerodactyly,
telangiectasia.
“Keutel syndrome”[8] is a rare autosomal recessive genetic
disorder characterized by abnormal diffuse cartilage
calcication, hypoplasia of the mid-face, peripheral pulmonary
stenosis, hearing loss, short distal phalanges (tips) of the ngers
and mild mental retardation.
X-ray usually demonstrates opacity similar to that of a normal
bone. Histologic sections of the auricle demonstrated spicules
of the lamellar bone with cement lines and osteocytes, stromal
component of adipose tissue, and fragments of elastic cartilage,
and woven bone. e osteoblastic activity was not prominent.
Because most cases are asymptomatic, there are no guidelines
for treatment of this condition. An improvement has been
reported aer conchal reduction by surgery. Our patient’s
complaint was only a mild discomfort when sleeping; thus,
he denied any surgical intervention.
conclusIon
True auricular ossication is a quite rare clinical entity with
unclear pathogenesis and one should have in mind that
there is always the possibility of a serious co-existed disease
like endocrinopathy. Petried ear is usually asymptomatic.
Radiographs demonstrated opacities consistent with
ossification and true bone formation in both auricular
cartilages. In cases of extreme discomfort, surgical intervention
like conchal reduction through a posterior incision has been
employed.
references
1. High WA, Larson MJ, Hoang MP. Idiopathic bilateral auricular
ossicans: A Case Report and Review of the Literature. Arch
Pathol Lab Med 2004;128:1432-4.
2. Mastronikolis NS, Zampakis P, Kalogeropoulou C, Stathas T, Siabi
V, Geropoulou E, et al. Bilateral ossication of the auricles: An
unusual entity and review of the literature. Head Face Med
2009;5:17.
3. Bochdalek G. Psysiologische Verkno cherung der Aurecula.
1866;89:33-46.
4. Scherrer F. Calcication and ossication of the external ears.
Ann Otol 1932;41:867-85.
5. Gordon D. Calcication of auricular cartilage. Arch Intern Med
1964;112:73-7.
6. DiBartolomeo JR. The petried auricle: Comments on ossication,
calcication and exostoses of the external ear. Laryngoscope
1985;95:566-76.
7. Winterbauer RH. Multiple telangiectasia, Raynaud'S phenomenon,
Figure 2: Ossication of both pinna seen in X-ray both mastoid–Law’s viewFigure 1: External appearance of rigid pinna

32 Indian Journal of Otology | January 2011 | Vol 17 | Issue 1 |
Karthikeyan, et al.: Petried ear
sclerodactyly, and subcutanious calcinosis: A syndrome mimicking
hereditary hemorrhagic telangiectasia. Bull Johns Hopkins Hosp
1964;114:361-83.
8. Munroe PB, Olgunturk RO, Fryns JP, Van Maldergem L, Ziereisen F,
Yuksel B, et al. Mutations in the gene encoding the human matrix
How to cite this article: Karthikeyan P, Bala AG, Priya K. Petried
ear. Indian J Otol 2011;17:30-2.
Source of Support: Nil. Conict of Interest: None declared.
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