Disregard of cholesteatoma in congenital aural stenosis

Bezold's abscess secondary to os tympanicum cholesteatoma in Goldenhar syndrome

OBJECTIVES

The diagnosis of Bezold's abscess can be challenging especially when craniofacial malformations imply facial and cervical morphological asymmetries. In addition, craniofacial malformations might predispose to the occurrence and atypical diffusion pathways of suppurative processes originating from abnormally developed temporal bone structures.

METHODS

A 30-year-old female presented with a left laterocervical swelling, worsening over time. The female was affected by Goldenhar syndrome. CT and MRI were performed.

RESULTS

CT revealed a dysmorphic os tympanicum and a deep cervical abscess in continuity with its cavity. Drainage of the cervical abscess was performed but a subsequent brain MRI detected a large cholesteatoma that was removed with left lateral petrosectomy.

CONCLUSIONS

Radiology has a crucial role in the diagnosis and planning of the treatment of Bezold's abscesses, particularly in syndromic patients. MRI, in this case, helped in diagnosing the presence of the cholesteatoma and consequently appropriately approach the surgical removal.

Congenital Cholesteatoma in a Case of Congenital Aural Atresia: A Case Report

Congenital external canal atresia is one of the congenital ear anomalies that can occur in patients. Similarly, congenital cholesteatoma is also another congenital disease that is often diagnosed in early adulthood. Both the above-mentioned diseases can occur independently but the presence of both these entities is a rare occurrence and needs a high degree of suspicion aided by a computed tomography scan to make the diagnosis. We are presenting a case of a sixteen-year-old patient who presented with unilateral ear anomaly, earache, facial palsy, and postaural swelling and was diagnosed as a right sided congenital aural atresia with congenital cholesteatoma. He was surgically managed with right-sided modified radical mastoidectomy with canaloplasty and closure of mastoid fistula under general anesthesia.

Is there a role for computed tomography scanning in microtia with complete aural atresia to rule out cholesteatoma?

OBJECTIVE

To determine if radiologic imaging is necessary to rule out cholesteatoma in patients with congenital aural atresia.

METHODS

A retrospective chart review of patients attending the BC Children's Hospital Microtia Clinic from January 1, 1990 through April 17, 2017 was undertaken. Patients with complete atresia of the external canal were included in the study. Available radiologic imaging and clinical records were examined for the presence or absence of cholesteatoma.

RESULTS

Of the 125 charts reviewed, 102 met criteria for inclusion in the study and 79 had three-dimensional imaging completed. None of these 102 patients had radiologic or clinical evidence of cholesteatoma.

CONCLUSION

Computed tomography and/or magnetic resonance imaging remains an essential modality in the work-up of selected patients with microtia/atresia. It may be unnecessary in the follow-up of certain patients to rule out a congenital cholesteatoma. This imaging avoidance may reduce exposure to radiation, the potential need for general anaesthesia, and unnecessary financial cost.

Congenital Aural Stenosis: Clinical Features and Long-term Outcomes

The aim of the present study was to comprehensively evaluate the clinical features and long-term outcomes of congenital aural stenosis (CAS). This study presents a retrospective review of patients who underwent meatoplasty for CAS at a tertiary referral hospital from 2008 to 2015. A total of 246 meatoplasty procedures were performed on 232 patients in the present study. We performed multivariate regression analysis. Except in the age < 6 years group, no significant difference was observed among different age groups for cholesteatoma formation, p > 0.05. Except for the stenosis of the external auditory canal (EAC) (>4 mm) group, the other stenosis of EAC groups were not associated with cholesteatoma formation, p > 0.05. Postoperative air-bone gaps (ABG) less than 30 dB occurred in 77.3% (99/128) of the patients, and the Jahrsdoerfer score was associated with postoperative ABG, p < 0.001. The complication rate of CAS was 13.8% (20/144), and males showed a higher risk for postoperative complications (OR, 6.563; 95% CI, 1.268-33.966, p = 0.025). These results indicate that meatoplasty was an effective surgical intervention for CAS, showing a stable hearing outcome with prolonged follow-up. There was no significant difference between the cholesteatoma and no cholesteatoma groups for hearing outcomes, p > 0.05.

Imaging findings in a case with cholesteatoma in complete aural atresia

We report a case of cholesteatoma in congenital aural atresia in which preoperative imaging analysis provided useful information. A 30-year-old man with total aural atresia had had ear symptoms on his right side for 10 years. Evaluation by computerized tomography and magnetic resonance imaging suggested that the mass in the atretic external auditory canal and the anterior part of the mastoid was cholesteatoma and that the mass in the posterior part of the mastoid was inflammatory granulation tissue and chronic osteomyelitis. Three-dimensional fluid-attenuated inversion recovery images showed increased signals in the labyrinth. The extent of the cholesteatoma revealed during surgery was consistent with the preoperative image findings. Imaging analysis provides useful information for management of congenital aural atresia, and combined examination with computerized tomography and magnetic resonance imaging could be beneficial for preoperative evaluation of state of ears in cases of congenital aural atresia.