Osteomas of Temporal Bone: A Retrospective Study

Questioning the value of stalk drilling after external auditory canal osteoma excision: case series, literature review, and meta-analysis

OBJECTIVES

To question the value of drilling the site of the stalk ("insertion site" or "stalk" drilling) of a pedunculated external auditory canal osteoma (EACO) in reducing recurrence.

DATA SOURCES

A retrospective medical chart review of all patients treated for EACO in one tertiary medical center, a systematic literature review using Medline via "PubMed", "Embase", and "Google scholar" search, and a meta-analysis of the proportion for recurrence of EACO with and without drilling.

RESULTS

The local cohort included 19 patients and the EACO origin was the anterior EAC wall in 42% and the superior EAC wall in 26%. The most common presenting symptoms were aural fullness and impacted cerumen (53% each), followed by conductive hearing loss (42%). All patients underwent post-excision canaloplasty, and one sustained EACO recurrence. Six studies suitable for analysis were identified (63 EACOs). Hearing loss, aural fullness, otalgia, and cerumen impaction were the most common clinical presentations. The most common EACO insertion site was the anterior EAC wall (37.5%), followed by the superior EAC and posterior walls (25% each). The inferior EAC wall was least affected (12.5%). There was no significant difference in recurrence between EACOs whose stalk insertions were drilled (proportion 0.09, 95% confidence interval [CI] 0.01-0.22) to the ones whose insertion was not drilled (proportion 0.05, 95% CI 0.00-0.17). The overall recurrence proportion was 0.07 (95% confidence interval 0.02-0.15).

CONCLUSION

EACO insertion site drilling does not reduce recurrence and should be avoided in the absence of a definite pedicle projecting to the EAC lumen.

Long-Term Surgical Results of Cortical Mastoid Bone Osteomas

Background: Though osteomas can commonly arise in the cranial bones, an extra canalicular mastoid bone location is a rare entity with less than 200 cases described to date. We present three cases of cortical mastoid bone osteomas and compare them with cases presented in the literature. Methods: In this study, we used a retrospective chart analysis. Results: All three patients presented after years of progressively increasing postauricular swelling without symptoms. Temporal bone non-contrast CT allowed accurate preoperative diagnosis. Surgical treatment was performed for cosmetic issues with minimal postoperative morbidity. Complete excision was achieved in all cases, and to date, there is no evidence of recurrence. Conclusions: Mastoid osteomas are rare benign slow-growing tumors. They usually present as a painless cosmetic disfigurement and are otherwise asymptomatic. Surgical excision is the treatment of choice when they cause esthetic discomfort or are symptomatic. Recurrences are infrequently reported.

Congenital duplicated incus in the mastoid cavity

Many congenital ossicular chain malformations exist, usually involving ossicular deformities, fixation, absence, or discontinuity. Duplication of ossicles has not been reported, much less a duplicated ossicle located in the mastoid. We present a case of a patient who had a duplicated incus in the mastoid antrum.

Spongiotic osteoma in the external auditory canal: Two cases of a rare tumor

Osteoma of the external auditory canal is a rare benign tumor with an estimated incidence of 0.05% of total otologic surgeries. In most cases, an osteoma in the external auditory canal does not cause symptoms because the tumor grows slowly and does not occlude the ear canal. However, if the mass grows to occlude the external auditory canal, several symptoms can occur, including conductive hearing loss, aural fullness, and keratin debris accumulation. We present two cases of this rare tumor in a 23-year-old woman and a 19-year-old man. The mass was surgically excised at the level of the peduncle under local anesthesia with microscope assistance. The base of the excised mass was drilled with a diamond burr to remove all osseous lesions. Histopathologic findings showed spongiotic osteomas. In these cases, patients had symptoms of aural fullness, although the osteomas did not completely occlude the external auditory canal, and the symptoms improved after surgical excision without recurrence.