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Munjal T, Kullar PJ, Alyono J. External Ear Disease: Keratinaceous Lesions of the External Auditory Canal. Otolaryngol Clin North Am 2023; 56:897-908. [PMID: 37550109 DOI: 10.1016/j.otc.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Keratosis obturans (KO) and external auditory canal cholesteatoma (EACC) are two distinct keratinaceous lesions of the external ear. This article reviews the signs, symptoms, pathophysiology, workup, and treatment of each. Patients with either pathology can often be managed in the clinic with debridement; however, EACC is more likely to involve osteonecrosis and require more extensive operative management if disease is not confined to the canal on account of the bony erosion characteristic of cholesteatoma. If required for extensive disease, surgical approaches to both pathologies are similar.
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Affiliation(s)
- Tina Munjal
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Palo Alto, CA 94304, USA
| | - Peter J Kullar
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Palo Alto, CA 94304, USA
| | - Jennifer Alyono
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Palo Alto, CA 94304, USA.
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He G, Zhu Z, Xiao W, Wei R, Chen L, Xu Y, Liu P, Li H. Cholesteatoma debridement for primary external auditory canal cholesteatoma with non-extensive bone erosion. Acta Otolaryngol 2020; 140:823-826. [PMID: 32513028 DOI: 10.1080/00016489.2020.1772505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: External auditory canal (EAC) cholesteatoma (EACC) is rare and its treatment for different lesions has not yet been standardized.Objective: This study aimed to explore the clinical features of EACC with bone erosion, and to assess the curative effect of initial complete cholesteatoma debridement (ICCD).Material and methods: Clinical characteristics and prognosis of 41 ears were analyzed retrospectively.Results: The bone erosion of the EAC was most commonly affected on the posterior wall (37 ears), next by the inferior wall (34 ears), the anterior wall (30 ears) and the superior wall (23 ears). Hearing loss (36 ears) was the most common symptom, followed by otalgia (33 ears), otorrhea (18 ears), tinnitus (11 ears) and pruritus (3 ears). The hearing impairment of mean air conduction and air-bone gaps were improved from 39.2 dB to 22.7 dB, and 23.5 dB to 7.1 dB after the ICCD procedure, respectively. Four ears presented recurrence during the follow-up time and accepted a revision-debridement.Conclusion and significance: The ICCD might be applicable in the treatment of patients in the early stages and with non-extensive bone defect; however, close and long-term surveillance is essential and serial debridement is probable.
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Affiliation(s)
- Guanwen He
- Department of Otolaryngology, Ningde Municipal Hospital Affiliated of Fujian Medical University (Ningde Institute of Otolaryngology), Ningde, China
| | - Zhongshou Zhu
- Department of Otolaryngology, Ningde Municipal Hospital Affiliated of Fujian Medical University (Ningde Institute of Otolaryngology), Ningde, China
| | - Wenhui Xiao
- Department of Otolaryngology, First Affiliated Hospital of Fujian Medical University (Fujian Province Institute of Otolaryngology), Fuzhou, China
| | - Rifu Wei
- Department of Otolaryngology, Ningde Municipal Hospital Affiliated of Fujian Medical University (Ningde Institute of Otolaryngology), Ningde, China
| | - Liwen Chen
- Department of Otolaryngology, Ningde Municipal Hospital Affiliated of Fujian Medical University (Ningde Institute of Otolaryngology), Ningde, China
| | - Yangbin Xu
- Department of Otolaryngology, Ningde Municipal Hospital Affiliated of Fujian Medical University (Ningde Institute of Otolaryngology), Ningde, China
| | - Ping Liu
- Department of Otolaryngology, Ningde Municipal Hospital Affiliated of Fujian Medical University (Ningde Institute of Otolaryngology), Ningde, China
| | - Huifeng Li
- Department of Otolaryngology, Ningde Municipal Hospital Affiliated of Fujian Medical University (Ningde Institute of Otolaryngology), Ningde, China
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Cholesteatoma of the External Auditory Canal: Review of Staging and Surgical Strategy. Otol Neurotol 2019; 39:e1026-e1033. [PMID: 30212428 DOI: 10.1097/mao.0000000000001972] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION External auditory canal cholesteatomas (EACC) is insidious in nature and rare entity. There are only few case series on EACCs and surgical strategy is not standardized. OBJECTIVES 1) To elucidate etiology of EACC and cardinal features. 2) To suggest a practical staging of EACC. 3) To enumerate surgical management according to stage of EACC. STUDY DESIGN Retrospective study in a quaternary referral center of 31 consecutive cases of EACC. RESULTS Thirty-one patients with EACC were reviewed. Unilateral otorrhea 19 (61.2%), hearing loss 22 (70.9%), and otalgia 8 (25.8%) are cardinal symptoms. Sixteen primary and 15 secondary EACCs were treated. Bone erosion was observed in 20 cases. In the present series, stage III = 12 (38.7%), stage II = 8 (25.8%), stage I = 11 (35.4%) underwent definitive treatment by surgery. Canalplasty with reconstruction was done in 19 cases of stages I and II. Of 12 cases in stage III, 3 cases underwent canalplasty with reconstruction. Subtotal petrosectomy was done in five cases. Intact canal wall mastoidectomy with canalplasty in two cases and radical mastoidectomy in two cases. Fascia, cartilage, muscle, and bone dust were used for reconstruction. Median follow-up period was 6 years and no recurrence of cholesteatoma was observed. CONCLUSION EACC is unique entity. Intraoperative and radiological findings assist in correct and practical staging of EACC. Late stage presentations of EACC are common. Definitive surgical treatment in our series avoided recurrence of cholesteatoma.
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He G, Xu Y, Zhu Z. Clinical analysis of pediatric primary external auditory canal cholesteatoma. Int J Pediatr Otorhinolaryngol 2019; 118:25-30. [PMID: 30578992 DOI: 10.1016/j.ijporl.2018.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/08/2018] [Accepted: 12/08/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Pediatric primary external auditory canal cholesteatoma (EACC) is a rare disease. The present study aimed to explore the clinical features and prognosis of this disease. METHODS Clinical data of 41 ears with pediatric primary EACC were collected, and the clinical characteristics and prognosis were analyzed in this retrospective study. RESULTS A total of 35 patients (median age of 13 years) were recruited in this study. Of these, 13 suffered on the left side and 16 on the other side, while 6 suffered on the bilateral ears. A total of 35 ears had hearing loss, 26 had otalgia, 15 had otorrhea, 12 had tinnitus, and 4 had pruritus. The median course of the disease was 1 month. The bone destruction of the external auditory canal (EAC) was located on the inferior wall of 20 ears, the posterior wall of 22 ears, the superior wall of 15 ears, and the anterior wall of 15 ears. According to Shin's stages, 24 ears were in stage I, 2 in stage II, 15 in stage III. A total of 40 ears underwent transcanal cholesteatoma removal (TCR) and 1 underwent both TCR and tympanoplasty. Finally, 33 ears were followed up postoperatively, and only 1 ear presented recurrence. CONCLUSION The posterior wall of the EAC is the most commonly affected wall, and the involvement of multiple walls is common. Due to the remodeling of the EAC bone in pediatric patients, the high stage lesions can be treated by minimally invasive surgical debridement combined with a close follow-up postoperatively.
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Affiliation(s)
- Guanwen He
- Department of Otolaryngology, Ningde Municipal Hospital Affiliated of Fujian Medical University (Ningde Institute of Otolaryngology), Ningde, Fujian, 352100, China.
| | - Yangbin Xu
- Department of Otolaryngology, Ningde Municipal Hospital Affiliated of Fujian Medical University (Ningde Institute of Otolaryngology), Ningde, Fujian, 352100, China
| | - Zhongshou Zhu
- Department of Otolaryngology, Ningde Municipal Hospital Affiliated of Fujian Medical University (Ningde Institute of Otolaryngology), Ningde, Fujian, 352100, China
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Abstract
BACKGROUND Treatment of external auditory canal cholesteatoma (EACC) has been a question of debate. To our knowledge and according to a systematic review of endoscopic ear surgery (EES) in 2015, this study describes for the first time the technique and outcome by solely transcanal EES for EACC. STUDY METHOD Retrospective case series, level of evidence IV. METHODS Between October 2014 and December 2016, nine patients with unilateral EACC have been treated by EES. Using a bimanual technique, canaloplasty has been performed using tragal perichondrium, cartilage, or artificial bone. Symptoms, signs, and reconstruction technique have been assessed and the primary endpoint: healing time was compared with benchmark values in the literature. RESULTS During the 26 months study period all of our nine Naim stage III EACCs were successfully treated by EES with median healing time of 23.8 days. EACC limited to the external auditory canal (Naim stage III) represented an ideal target for EES minimizing tissue damage and thus median healing time compared with retroauricular (42-56 d) or endaural (59 d) surgical techniques. DISCUSSION Shorter healing time helped to reduce skepticism toward a surgical treatment of EACC from the patient's perspective. Moreover, EES relied on reduced bulky equipment, dressing time, and complex maintenance compared with microscopic techniques. CONCLUSION Transcanal endoscopic surgery is a valid treatment option for EACC up to Naim stage III. Moreover, the described procedure fosters in our eyes the teaching of our residence to get familiar with the basic steps of EES.
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Jang CH, Kim YY, Seong JY, Kang SH, Jung EK, Sung CM, Kim SB, Cho YB. Clinical characteristics of pediatric external auditory canal cholesteatoma. Int J Pediatr Otorhinolaryngol 2016; 87:5-10. [PMID: 27368435 DOI: 10.1016/j.ijporl.2016.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/08/2016] [Accepted: 05/09/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND & OBJECTIVE External auditory canal cholesteatoma (EACC) is caused by an invasion of squamous tissue into a localized area of periosteitis in the bony canal wall. The clinical characteristics of pediatric EACC are still unknown because of its rare occurrence. To date, only a single paper has reported that pediatric EACC has a less aggressive growth pattern compared to adult EACC. Further studies are required to understand the clinical behavior of EACC, i.e., its aggressiveness. The purpose of this study was to evaluate the clinical characteristics of pediatric EACC. MATERIALS AND METHODS The clinical records of all patients diagnosed with EACC in our department from January 1, 2012 to February 29, 2016 were retrospectively reviewed, focusing on the extension of bone erosion, symptoms, and clinical findings. RESULTS Seven patients had primary pediatric EACC (age range, 5-17 years). All patients showed unilateral EACC. Otalgia and intermittent otorrhea were common symptoms. Bacterial cultures were performed for four patients with otorrhea, which was controlled by diluted vinegar irrigation with a topical antibiotic solution. The most common bone destruction sites were the inferior and posterior walls. All patients required surgical treatment. Four patients (patient nos. 1, 3, 4, and 5) were treated via a postauricular transcanal approach. Three patients (patient nos. 2, 6, and 7) required mastoidectomy. CONCLUSION Pediatric EACC is not less aggressive than adult EACC. Therefore, early diagnosis and adequate treatment are necessary. Further studies are required to elucidate the clinical features of pediatric spontaneous EACC.
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Affiliation(s)
- Chul Ho Jang
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea.
| | - Young Yoon Kim
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Jong Yuap Seong
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Sung Hoon Kang
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Eun Kyung Jung
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Chung Man Sung
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Seung Beom Kim
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Yong Beom Cho
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
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Kim CW, Baek SH, Lee SH, Kim GW, Cho BK. Clinical characteristics of spontaneous cholesteatoma of the external auditory canal in children comparing with cholesteatoma in adults. Eur Arch Otorhinolaryngol 2013; 271:3179-85. [PMID: 24258852 DOI: 10.1007/s00405-013-2820-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 11/07/2013] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to investigate the characteristics of external auditory canal cholesteatoma (EACC) in children through evaluation of the clinical and radiologic features as well as treatment outcomes. The clinical records were retrospectively reviewed for children under 15 years of age diagnosed with spontaneous EACC between March 2004 and December 2011. The clinical data of adults diagnosed with spontaneous EACC during the same period were evaluated to compare with EACC in children. Eight patients (3 males and 5 females) with pediatric EACC and 18 patients (7 males and 11 females, 20 ears) with adult EACC were included within the boundary of the study. The mean ages were 12.4 years (age range 9-15) for pediatric EACC and 49.8 years (age range 29-79) for adult EACC patients. Follow-up periods ranged from 8 to 86 months (mean 32.5 ± 8.62) in pediatric EACC and from 6 to 72 months (mean 22.2 ± 5.36) in adult EACC. Pediatric EACC, showed involvement most commonly in the posterior wall, while the inferior wall was most commonly involved in adult EACC. Pediatric EACC tended to show a more focal involvement and was not as extensive as adult EACC. Extension into the adjacent structures was similar in both groups, but bony destruction was more common in the adult group. Two children and eight adult patients were treated with surgery, but four adult cases needed more extensive surgical treatment because their disease was widely spread to included areas such as the mastoid segment of facial nerve and the temporomandibular joint. Six pediatric cases treated with conservative management showed no progression of disease on physical examination at the last visit, but two cases of adults progressed and required canaloplasty. Pediatric EACC shows less aggressive behavior compared to adult EACC. Adequate management may work better in pediatric than in adult EACC, even though the treatment modality is conservative management.
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Affiliation(s)
- Chang Woo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hallym University, 445 Gil-Dong, Gangdong-gu, Seoul, 134-701, Korea,
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Laterality of acquired cholesteatoma and handedness. Otol Neurotol 2012; 33:996-7. [PMID: 22722147 DOI: 10.1097/mao.0b013e31825e73e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate a possible contribution of handedness to the development of unilateral acquired cholesteatoma. PATIENTS All patients with unilateral acquired cholesteatoma attending otorhinolaryngology clinic between August 2009 and February 2012 were asked about their handedness. RESULTS The study group consisted of 237 right-handed and 31 left-handed (11.8%) patients who included 158 male (59%) and 79 female subjects with an age range of 6 to 81 years (mean, 38.6 yr). There were no ambidexters in the present cohort. Overall, unilateral cholesteatoma involved 146 right (54.5%) and 122 left ears (45.5%). Ten of 31 patients (32.3%) with left hand predominance were female subjects. In the unilateral disease, the right ears were affected more frequently in patients with right-hand dominance (59.5%), and the left ears were more frequently affected in the left-handed patients (83.9%); this difference was statistically significant (p < 0.0001). The sex differences in the distribution of cholesteatoma side and handedness were not statistically significant (p = 0.098). CONCLUSION The strong relationship has been observed between the patient's handedness, and laterality of the unilateral acquired cholesteatoma may have contribution in the multifactorial process of cholesteatoma formation.
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Dubach P, Mantokoudis G, Caversaccio M. Ear canal cholesteatoma: meta-analysis of clinical characteristics with update on classification, staging and treatment. Curr Opin Otolaryngol Head Neck Surg 2010; 18:369-76. [DOI: 10.1097/moo.0b013e32833da84e] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Current Opinion in Otolaryngology & Head and Neck Surgery. Current world literature. Curr Opin Otolaryngol Head Neck Surg 2010; 18:466-74. [PMID: 20827086 DOI: 10.1097/moo.0b013e32833f3865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Classification of external auditory canal cholesteatoma by computed tomography. Clin Exp Otorhinolaryngol 2010; 3:24-6. [PMID: 20379398 PMCID: PMC2848314 DOI: 10.3342/ceo.2010.3.1.24] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Accepted: 02/16/2010] [Indexed: 11/08/2022] Open
Abstract
Objectives We propose here a classification system for external auditory canal cholesteatoma (EACC). We classified the EACC by the computed tomography findings and clinical findings of the patients, and we evaluated the EACC characteristics by the proposed staging system. Methods Stage classification was done according to the results of temporal bone computed tomography and the clinical findings of the patients. Stage I indicates that the EACC lesion is limited to the external auditory canal. Stage II indicates that the EACC lesion invades the tympanic membrane and middle ear. Stage III indicates that the EACC lesion creates a defect of the external auditory canal and it involves the air cells in the mastoid bone. Stage IV indicates that the EACC lesion is beyond the temporal bone. Between 1996 and 2006, 29 patients with EACC and who underwent surgery were prospectively collected. This study was comprised of 16 males and 13 females with a mean age of 22.8±15.0 yr. We reviewed the characteristics and results of surgery by our proposed staging system. Results A total of 29 patients who underwent operation due to EACC were classified by this system, and the number of stage I, II, III, and IV cases was 14, 3, 10, and 2, respectively. Symptoms such as otorrhea, hearing impairment and otalgia occurred in 12, 17, and 17 cases, respectively. The most common wall invaded by EACC was the inferior wall. The number of cases that had a spontaneous, congenital, post-traumatic, post-inflammatory or tumorous origin was 14, 9, 2, 2, and 1, respectively. Cholesteatoma recurred in 2 patients after surgery. Both cases were stage 1 and both were caused by congenital disease. There were 3 cases with meatal stenosis after surgery, and their primary disease was congenital. Conclusion This proposed staging is simple and easily applicable for use when deciding the treatment plan for patients with EACC.
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Current Opinion in Otolaryngology & Head & Neck Surgery. Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:494-8. [PMID: 19907224 DOI: 10.1097/moo.0b013e32833385d7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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