External auditory osteoma

Factors Related to Cholesteatoma Formation in External Auditory Canal Osteomas and Treatment Algorithm

Objectives: Osteomas in the external auditory canal (EAC) can lead to stenosis, and impair epithelium migration and self-cleaning capability, thereby trapping keratinized epithelium and triggering the development of cholesteatoma. Our study aims to identify the risk of cholesteatoma development in patients with osteoma and proposes a stepwise approach to managing patients with EAC osteoma. Methods: The maximum diameter of the osteoma was measured in axial and coronal views on high-resolution computed tomography (HRCT). We calculated the relative obstruction ratio caused by the osteoma in the axial and coronal views. Prior to surgery, otoscopy was employed to identify pedicle formation. The patients were categorized into 2 groups based on the presence of cholesteatoma. Results: We identified 43 patients diagnosed with EAC osteoma. A total of 9 (20.9%) patients with EAC osteomas developed cholesteatoma and the other 34 (79.1%) did not. The maximum diameter of osteomas with and without cholesteatoma was 12.67 ± 4.09 and 7.67 ± 3.27 mm, respectively (P < .001). In the group without cholesteatoma, 21 osteomas had pedicles while the other 13 did not. In the cholesteatoma group, 2 osteomas had pedicles and 7 did not (P = .037). No difference was observed in the relative obstruction ratio between these 2 groups. Conclusions: Our findings indicate that larger osteomas are more likely to develop cholesteatoma, while the formation of a pedicle may reduce the occurrence of cholesteatoma. In symptomatic patients, preoperative evaluation, including HRCT and otoscopy, is vital for assessing the extent of the osteoma and the potential coexistence of cholesteatoma. These factors are critical for preoperative consultations and surgical planning.

Cartilaginous Choristoma of the External Auditory Canal

Cartilaginous choristoma is a rare benign lesion of the external auditory canal, generally found incidentally on physical exam in an asymptomatic patient. Our patient had the largest cartilaginous choristomas described in the literature to date. Additionally, this reviews the nomenclature and differential diagnoses of masses within the external auditory canal.

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.

Ossicular osteoma of the malleus—A rare diagnosis of middle ear mass

Osteoma of the middle ear (MEO) is a rarity. Due to the benign nature and slow growth rate, MEO are often occasionally found by chance. Possible unspecific clinical symptoms may be conductive hearing loss, tinnitus, effusion, and a sense of fullness. If the osteoma is small and not visible in the otoscopic inspection, it may be confused with other conductive hearing loss etiologies, such as otosclerosis. Nevertheless, one should be aware of this rare but important differential diagnosis of middle ear lesions. This article presents an MEO case causing conductive hearing loss and outlines the diagnostic approach with computed tomography.

Osteomas of temporal bone: a rare presentation

Osteoma of the temporal bone is an unusual benign slow-growing tumour composed of mature lamellar bone. It is a single pedunculated mass that often occurs unilaterally. Osteomas of external auditory canal are more common than in the other parts of temporal bone. Clinical presentation includes ear pain, hearing loss, tinnitus or vertigo. More often these lesions are an incidental finding during radiographic evaluation. Surgical excision of the osteoma is preferred in cases with impending complications. Here, we report a 36-year-old woman who came with problems of ear discharge, ear pain, hearing loss and occasional bleeding from the ear. She was diagnosed with osteoma of temporal bone with erosion of lateral semicircular canal and facial canal. Osteoma was excised and the defective areas were reconstructed.

[On the question of choosing a surgical approach when removing an osteoma of the external auditory canal]

The article presents the results of the surgery treatment of osteomas in external auditory canals of 24 patients. The quantity and the location of osteomas with respect to the tympanic membrane determine a surgical approach. Retroauricular approach (n=19) was applied in cases of multiple osteomas or their close location with the tympanic membrane. Single osteomas located laterally of the isthmus of the external auditory canal were removed with the endaural approach (n=5). The overall follow-up period was 5 years. Postsurgical supervision did not register illness recurrence or any complications such as the trauma of the tympanic membrane or the stenosis of the external auditory canal.

Canalplasty for Exostosis Removal Comparing Microscopic Versus Endoscopic Ear Surgery Techniques

OBJECTIVE

To compare an endoscopic versus microscopic approach to removal of exostoses and osteomas in canalplasty procedures.

STUDY DESIGN

Retrospective case review.

SETTING

Private and tertiary referral centers.

PATIENTS

Adult patients requiring canalplasty procedures performed either microscopically or endoscopically for removal of exostosis or osteoma and/or canal stenosis.

INTERVENTION

Microscopic or endoscopic canalplasty.

MAIN OUTCOME MEASURE

Major outcome measures included assessment of hearing improvement as well as rates of major and minor complications. Standard audiological data were collected before and after the operative procedure. Major complications queried included stenosis, perforation of the tympanic membrane, hearing loss, facial palsy, and osteomyelitis. Minor complications queried included signs of poor wound healing, graft failure, and bleeding or discharge.

RESULTS

Forty three canalplasties were performed on 36 patients. Audiometric tests did not significantly differ between endoscopic and microscopic surgeries. There was a moderate linear relationship between date of surgery and duration of surgery for the endoscopic technique, with more recent surgeries taking less time. No major complications were noted. However, significantly fewer endoscopic cases had evidence of minor postoperative complications relative to microscopic cases.

CONCLUSIONS

An endoscopic approach to canalplasty is a safe and minimally invasive technique. Significantly fewer postoperative complications occurred after endoscopic canalplasty procedures as compared with microscopic procedures. Endoscopic repair may be preferred to microscopic repairs due to the improved view of the end of the instruments while maintaining a minimally invasive approach with what is likely a decreased operative time as well.

[The effectiveness of the use of local antibacterial drugs in the postoperative period in a patient with a neoplasm of the external auditory canal]

This article presents clinical case of external auditory canal osteoma and postoperative management of this patients. In this publication the etiology of this pathology, as well as the clinical manifestations that accompany this pathological condition are described. We present a literature review and our own experience of treatment this group of patients.

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.

Endoscopic transcanal removal of external auditory canal osteomas

Background

External auditory canal (EAC) osteomas are rare, slow-growing benign neoplasms. Microscopic surgical excision had been reported for symptomatic osteomas. However, there was no study published on the feasibility of transcanal endoscopic ear surgery (TEES) for EAC osteoma. In this study, we propose two methods of TEES for symptomatic EAC osteomas and report the surgical outcomes of our patients.

Methods

Fifteen patients diagnosed with symptomatic EAC osteoma who underwent TEES were recruited at two otolaryngology referral centers. The extent of osteoma and degree of EAC stenosis was calculated based on high-resolution computed tomography (HRCT) imaging. We divided all the patients into two groups, solitary pedunculated osteoma or broad-based osteomas. The postoperative outcomes and complications were recorded for at least 6 months of outpatient follow-up.

Results

In this study, twelve patients with solitary osteoma underwent the first method, a direct transcanal removal procedure. In this approach, only a small bare bony area remained postoperatively, and it healed completely within 1 month. Three patients with broad based osteoma underwent the second method, a transcanal approach involving a skin flap. The degree of stenosis in all patients ranged from 29% to 90%. All of them could be treated completely through a transcanal endoscopic approach. No intraoperative or postoperative complications were noted during follow-up, and no canal stenosis and no recurrences were noted during at least 6 months of follow-up.

Conclusions

This endoscopic transcanal approach to EAC osteomas demonstrated good results for lesion removal without recurrence or intraoperative complications.

Mastoid osteoma in a prehispanic cranium (1390 A.D.) from Northern Chile

OBJECTIVE

Osteomas are slow-growing benign tumors that can affect the skull, most frequently the parietal and frontal. Temporal bone osteomas are more common in the external acoustic meatus and exceptional in the mastoid region. The rarity of mastoid osteomas is confirmed by the fact that very few cases have been reported in the clinical and paleopathological literature. The aim of this paper is to report a new paleopathological case of mastoid tumor in a Pre-Hispanic adult cranium.

MATERIALS

The skull derives from the Chunchuri (today Dupont-1 site) Pre-Hispanic site in Northern Chile (1390 A.D).

METHODS

Macroscopical examination and high-resolution tomography were used to assess the cranium.

RESULTS

The CT scan revealed a well demarcated lesion suggestive of a mastoid osteoma.

CONCLUSIONS

This case adds new evidence regarding the antiquity of primary neoplasms in ancient populations and reinforces the importance of high resolution imaging in paleopathological research.

SIGNIFICANCE

Due to the antiquity of the remains this is probably the oldest reported case of mastoid osteoma.

LIMITATIONS

The patrimonial nature of the remains did not allow histopathological studies.

SUGGESTIONS FOR FURTHER RESEARCH

Further intensive review of archeological skeletal collections is needed to better understand the epidemiology of neoplastic lesions in past populations.

Ear and Temporal Bone: Cartilaginous and Osseous Pathologies

Although the majority of conditions involving the ear and temporal bone are inflammatory or epithelial based, cartilage and osseous entities will also be encountered. The pathologic examination of these underlying cartilaginous and osseous structures and their histologic findings and associated differential diagnoses will be discussed. Correlation with clinical and imaging findings are also critical for accurate determination of the pathologic entity.

[The tumors of the ear]

Any cutaneous lesion of the outer ear must be managed jointly by a dermatologist and an ENT, regardless of the age of the patient. The presence of a malignant cutaneous carcinoma (Squamous cell carcinoma or melanoma) of the pavilion requires a minimum extension assessment by a cervical ultrasound, CT-scan and MRI will be prescribed according to the degree of infiltration and the presence of clinics signs (lymphadenopathy, facial paralysis, cognitive impairment). A polyp of the external auditory meatus must be systematically biopsied in consultation and, if necessary, in the operating room with fresh anatomopathological analysis. Any "otitis externa", which does not progress favorably under local treatment, must lead to eliminate a tumoral pathology of the external acoustic meatus or of the middle ear. Any suspicion of cholesteatoma should lead to an ENT consultation to confirm the diagnosis and consider its treatment to limit the auditory dysfunction. Any unilateral neurosensorial hearing loss or unilateral vestibular involvement with normal otoscopy should lead to eliminate a inner ear tumor by an MRI of the inner ear and the ponto-cerebellar angle in millimeter sections.

Exostoses of the external auditory canal

Ear canal exostoses are bilateral, usually symmetric multiple bony growths occurring in the medial portion of the external auditory canal. Also known as surfer’s ear, exostosis is thought to be a reactive process from repeated stimulation by cold water and is much more common than external auditory osteoma. Exostoses are usually asymptomatic and discovered on routine otoscopy. Indications for surgical treatment are recurrent otitis externa, hearing loss, otalgia and other conditions in which access medial to the exostoses is required. Surgery is not risk-free and postoperative complications are the most important factor for negative impact on the patient’s health-related quality of life. This review offers an overview of the recent advances in the understanding of this condition, with a special focus on the etiology and physiopathology of this condition, the different surgical procedures and their outcomes, the risk factors for recurrence and the results of preventive measures. Finally, this review suggests the need for the otological surgeon to acquire a great deal of experience before undertaking surgical treatment of exostoses as it is a challenging operation and, besides expertise, demands great patience and extreme care in order to achieve good results.