Intralesional steroid injection for the management of otohematoma

Treatment of Auricular Pseudocyst with Intralesional Steroid: A Study with Short-Term Follow-Up

Introduction

A pseudocyst is an uncommon, painless, benign cystic swelling on the lateral surface of the auricle with an unknown etiology. Various treatment modalities have been used with varying rates of success as this condition has high propensity for recurrence. We have used a minimally invasive treatment method for this condition to evaluate its efficacy in our setup.

Patients and Methods

This is a prospective study carried out in the department of ENT of Chitwan Medical College from May 2018 to April 2020. Complete aspiration of the pseudocyst with intralesional steroid (40 mg, triamcinolone acetonide) injection was done in 30 patients. They were followed up weekly for 4 weeks. Additional doses were injected in cases with persistence or recurrenqce before 3 weeks. Disappearance of the swelling, considered treatment success, was the main outcome. The total number of doses required for the complete resolution of the swelling along with the number of recurrences or complications, if any, were noted at the final follow-up at 4 weeks.

Results

All of our patients responded completely with intralesional triamcinolone. However, the total dose requirement for different patients varied. Out of the 30 patients, 21 (70%) responded to the single dose of the drug. Six (20%) required a second dose, while the remaining 3 (10%) patients required a third dose for complete resolution of the swelling. All three (10%) patients who received a third dose of triamcinolone complained of skin thickening, but there was no obvious cosmetic deformity.

Conclusion

Aspiration with intralesional steroid injection shows an immediate positive response in patients with auricular pseudocyst. It can achieve complete resolution of the swelling without any serious complications. Thus, it appears to be a simple and effective management of the condition in the short term.

Clinical Implications of Intralesional Steroid Injections in the Management of Otohematoma

OBJECTIVES/HYPOTHESIS

To evaluate the long-term effects of intralesional steroid injections (ILSIs) in patients with otohematoma and to suggest the clinical implications, especially with regard to the duration of otohematoma.

STUDY DESIGN

Retrospective analysis.

METHODS

Fifty-six patients were enrolled and classified into short-term otohematoma (n = 30) and long-term otohematoma (n = 26) groups according to the period of time after auricular trauma. After the first ILSI, all patients underwent weekly examinations during the 21-day observational period to determine the treatment outcomes and were then followed up for reevaluation for a maximum of 36 months. We considered ILSIs to be ineffective if the otohematoma persisted after the third ILSI, and we opted to perform surgical treatment in such cases. In addition, we evaluated early recurrence, late recurrence, and ILSI-related complications.

RESULTS

After up to three ILSIs, 29 out of 30 cases (96.7%) with short-term otohematoma and 20 out of 26 cases (76.9%) with long-standing otohematoma were treated without complications. Three patients with long-term otohematoma, however, experienced late recurrences at 4, 15, and 18 months, respectively. Seven patients who showed no response after ILSIs underwent surgical treatment. The duration of otohematoma (P = .043) and a higher initial aspirated fluid volume (P = .014) were shown to significantly increase the risk of treatment failure after ILSIs.

CONCLUSIONS

Multiple and immediate ILSIs in patients with otohematoma appear to be an effective treatment approach with no complications. Patients with short-term otohematoma showed better outcomes following ILSIs. The treatment approach may be optimized based on the duration and degree of otohematoma.

LEVEL OF EVIDENCE

4 Laryngoscope, 129:459-465, 2019.