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Seki S, Sugiyama T, Kikuchi S, Iino Y. Risk factors for occurrence and progression of external auditory canal cholesteatoma. Auris Nasus Larynx 2024; 51:295-300. [PMID: 37925251 DOI: 10.1016/j.anl.2023.09.005] [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] [Received: 05/17/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE External auditory canal cholesteatoma (EACC) is characterized by retained squamous debris within the external canal and variable amounts of localized bone destruction. The etiology of primary EACC remains incompletely understood. This study was conducted to analyze the clinical features and backgrounds of patients with primary EACC and to clarify the risk factors for the occurrence and progression of EACC. METHODS Sixty-nine ears of 62 patients diagnosed with primary EACC were included in this study (EACC group). Additionally, 74 ears of 60 patients with chronic otitis media (COM) with perforation who underwent tympanoplasty or myringoplasty were included as controls (COM group). We retrospectively investigated the clinical features, life history, and medical history of the patients in both groups. In addition, to investigate the risk factors for progression of EACC, we compared the clinical features and medical history of patients with stage IV (advanced) disease versus stage I + II (mild) disease. RESULTS The inferior wall of the bony canal was the main structure affected in patients with primary EACC of all stages. The following factors were significantly more common in the EACC than COM group: older age, female sex, left-sided disease, osteoporosis, renal dysfunction, anemia, and treatment with bisphosphonates. Among these, the most significant factor associated with EACC was renal dysfunction (odds ratio, 11.4; 95 % confidence interval, 2.32-55.9). The significant factors observed in patients with stage IV disease were younger age, male sex, posterior wall involvement, and otorrhea. Surgical treatment was required for more than half of the patients with stage III and IV EACC. CONCLUSION Patients with renal dysfunction are at risk of primary EACC. In particular, younger patients and relatively younger elderly patients with posterior wall involvement have a risk of progression to advanced-stage EACC. Canalplasty should be considered in patients with EACC who have these risk factors to prevent progression to advanced-stage disease.
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Affiliation(s)
- Saori Seki
- Department of Otolaryngology, Deafness and Middle Ear Surgicenter Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan; Department of Otolaryngology, Niigata Prefectural Central Hospital 205, Shinnan-cho, Joetsu, Niigata 943-0192, Japan.
| | - Tomonori Sugiyama
- Department of Otolaryngology, Deafness and Middle Ear Surgicenter Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Saori Kikuchi
- Department of Otolaryngology, Deafness and Middle Ear Surgicenter Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Yukiko Iino
- Department of Otolaryngology, Deafness and Middle Ear Surgicenter Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan; Department of Otolaryngology Head and Neck Surgery, Jichi Medical University Saitama Medical Center 1-847, Amanuma-cho, Omiya 330-0834, Japan
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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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Dongol K, Shadiyah H, Gyawali BR, Rayamajhi P, Pradhananga RB. External Auditory Canal Cholesteatoma: Clinical and Radiological Features. Int Arch Otorhinolaryngol 2021; 26:e213-e218. [PMID: 35602283 PMCID: PMC9122763 DOI: 10.1055/s-0041-1726047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/12/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction
External auditory canal cholesteatoma (EACC) is often misdiagnosed.
Objectives
To outline the clinical presentation of EACC, and to describe its radiological findings on high-resolution computed tomography (HRCT) of the temporal bone.
Methods
The clinical records of all patients diagnosed with EACC from April 2017 to March 2020 in a tertiary care center were retrospectively reviewed. The clinical presentation, the findings on the HRCT of the temporal bone, and the treatment provided were analyzed.
Results
A total of 9 patients, 7 males and 2 females, with a mean age of 30 years, were diagnosed with primary EACC. Six patients presented with otorrhoea, three, with otalgia, three. with hearing loss, and one with facial palsy. Some patients had multiple symptoms. The most common findings on otomicroscopy were destruction of the posterior and inferior canal walls, with cholesteatoma and intact tympanic membrane (six patients). Two patients had aural polyp, and one had a narrow ear canal due to sagging of the posterior canal wall. On HRCT, all nine patients showed soft-tissue density in the external auditory canal with erosion of the canal wall. The disease extended to the mastoid in eight cases, and to the cavity of the middle ear in one. There were three cases of dehiscence of the facial canal. Dehiscence of the dural and sinus plates was observed in two cases each. Eight patients underwent mastoidectomy, and one underwent debridement with canalplasty.
Conclusion
Review of the clinical and radiological findings is essential to reduce the rate of misdiagnosis.
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Affiliation(s)
- Kripa Dongol
- Department of Otorhinolaryngology, Institute of Medicine, Tribhuvan University Kathmandu, Nepal
| | - Hena Shadiyah
- Department of Otorhinolaryngology, Institute of Medicine, Tribhuvan University Kathmandu, Nepal
| | - Bigyan Raj Gyawali
- Department of Otorhinolaryngology, Institute of Medicine, Tribhuvan University Kathmandu, Nepal
| | - Pabina Rayamajhi
- Department of Otorhinolaryngology, Institute of Medicine, Tribhuvan University Kathmandu, Nepal
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Incidence and Risk of Various Disorders of the External Ear in Patients With Hearing Aids Treated in ENT Practices in Germany. Otol Neurotol 2020; 40:1076-1081. [PMID: 31335800 DOI: 10.1097/mao.0000000000002309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the relationship between the presence of a hearing aid (HA) and the occurrence of various disorders of the external ear, using data from ear, nose, and throat (ENT) practices in Germany from a nationwide, representative practice database. METHODS In the period between 2012 and 2016, the incidences of disorders of the external ear (ICD-10 groups H60 and H61) in patients with HA prescriptions were compared retrospectively with a control group without HA prescriptions (1:1 matching). RESULTS A total of 20,127 patients with HA prescriptions were compared with 20,127 controls. The highest 12-month incidences (HA vs. controls) were determined for "Impacted cerumen" (H61.2) (16.5% vs. 4.2%), "Unspecified otitis externa" (H60.9) (2.6% vs. 1.2%) and 'Acute noninfective otitis externa' (H60.5) (2.3% vs. 0.7%). The most significant risk increases for HA wearers were found for "Abscess of external ear' (H60.0, OR 10.03), "Other otitis externa' (H60.8, OR 6.00), and "Impacted cerumen' (H61.2, OR 4.55). A smaller risk increase was found for "Cholesteatoma of external ear' (H60.4, OR 2.26), among others. CONCLUSION In HA wearers, the risk of developing almost all of the diagnoses reviewed is significantly increased, especially for external auditory canal (EAC) furuncle, chronic otitis externa, and impacted cerumen. This study provides the first epidemiological evidence for HA as a risk factor for the rare EAC 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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Thompson C, Gohil R, Bennett A. Lyric hearing aid: a rare cause of benign necrotising otitis externa/external ear canal cholesteatoma. BMJ Case Rep 2017; 2017:bcr-2017-222719. [PMID: 29191823 DOI: 10.1136/bcr-2017-222719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An 80-year-old Caucasian man presented with an incidental and asymptomatic lesion in his right ear thought to be secondary to his use of hearing aids for presbycusis. He used Lyric hearing aids, designed for 24 hours-a-day use for 4 months at a time and had no other previous otological problems. He underwent a bony meatoplasty and vascular flap reconstruction via a retroauricular approach to remove the lesion for histological analysis and regrafting of the area. The lesion was confirmed on histopathology as an ear canal cholesteatoma.
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Affiliation(s)
- Christopher Thompson
- Anatomy Department, Division of Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Rohit Gohil
- Department of Otorhinolaryngology, NHS Lothian, Livingston, UK
| | - Alex Bennett
- Department of Otorhinolaryngology, NHS Lothian, Livingston, UK
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Reexamination of Etiology and Surgical Outcome in Patient With Advanced External Auditory Canal Cholesteatoma. Otol Neurotol 2017; 37:728-34. [PMID: 27295380 DOI: 10.1097/mao.0000000000001079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the etiology of advanced cases of external auditory canal (EAC) cholesteatoma (EACC), and to report the surgical management and outcomes based on canalplasty depending on the extent of adjacent structures involvement around the EAC. STUDY DESIGN Retrospective case review. SETTING University hospital. PATIENTS Participants comprised 28 patients (12 males, 16 females) ranging in age from 9 to 86 years old. All patients presented with advanced-stage EACC (Naim's classification: stage III/IV). INTERVENTION Surgery ranged from simple bony meatoplasty with cartilage graft repair to more enlarged EAC canalplasty combined with tympanoplasty. RESULT EACC was categorized as idiopathic in 22 patients and secondary EACC in six patients. Six patients with idiopathic EACC were receiving hemodialysis, one of whom showed bilateral pathology. Particularly in cases with epithelial invasion into the hypotympanum immediately adjacent to the jugular bulb, multi-layered repair including bone paste, post-auricular pedicled musculo-periosteal flap, auto cartilage, and temporalis muscle fascia were required. Five patients required revision surgery (17%), including one case of recurrent (reconstructed) cholesteatoma and three cases of perforation of the tympanic membrane. CONCLUSION In the majority of our series, underlying diseases followed with microangiopathy and angiogenesis could be possible candidates in the etiology of EACC. Enlarged bony meatoplasty and multilayered reconstruction surgery brought about self-cleaning and dried the EAC in advanced-stage EACC.
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Hashimoto K, Watanabe K, Adachi M, Kawase T, Kobayashi T. [External auditory canal cholesteatoma with chronic renal failure or hemodialysis]. NIHON JIBIINKOKA GAKKAI KAIHO 2014; 117:1179-1187. [PMID: 25726659 DOI: 10.3950/jibiinkoka.117.1179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND External auditory canal cholesteatoma (EACC) is a rare otologic disease, characterized by focal osteonecrosis, sequestration and overlying epithelial loss of the bony external auditory canal (EAC). The etiology and pathogenesis of EACC remain controversial. There are only 2 reports on the association between EACC and chronic renal failure (CRF)/hemodialysis (HD). METHOD & RESULT: (1) This study reviewed seven EACC cases with CRF. The mean age was 68.4 years (range: 56 -81 years), and the male-female ratio was 5:2. There were 12 ears with EACC (5 cases were bilateral and 2 cases were unilateral). The EACCs were found in the inferior or posterior inferior part of the EAC in 11 ears. The number of the ears in stage III or IV was 6. Five cases were on HD. (2) Seventy-six cases with CRF on HD were examined for EACC, and 2 out of those 70 cases were diagnosed as having EACC. (3) A comparative study of the 7 EACC cases on HD and 68 non-EACC cases on HD revealed no significant differences in the sex, age, period on CRF/HD, complications (diabetes mellitus or skin disease), smoking, ear cleaning and the use of an earphone or a hearing aid. CONCLUSION & DISCUSSION Six out of all 9 EACC cases with CRF developed bilaterally, and in the inferior or posterior inferior part of the EAC, which implies a common pathological condition that contributes to the development of EACC. The mean age of 9 patients with EACC was relatively older (66.7 years), therefore age-related changes in the EAC are suspected in the cases with CRF on HD. The patients with CRF on HD have a high incidence of EACC. This strongly suggests the association between EACC and CRF/HD, but the mechanism of this pathogenesis has not been revealed.
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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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Operative management of external auditory canal cholesteatoma: case series and literature review. The Journal of Laryngology & Otology 2013; 127:859-66. [DOI: 10.1017/s0022215113001850] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectives:To describe the clinical features of external auditory canal cholesteatoma, and to assess the outcome following bony meatoplasty with tragal cartilage and perichondrium graft repair.Methods:A retrospective review was carried out, comprising all patients with external auditory canal cholesteatoma who presented between January 2007 and December 2011. Patients underwent pre-operative audiometry and computed tomography imaging of the temporal bones, before undergoing bony meatoplasty via a postauricular incision. Pre- and post-operative comparisons were made of patients' otological symptoms and the otoscopic appearance of the external ear canal.Results and conclusion:Eight patients were included in the analyses. The median age of patients was 46.5 years (range 14–68 years), with a male to female ratio of 1:1. The median length of follow up was 16 months. The most common presenting features were unilateral otalgia and purulent otorrhoea. All patients had relatively advanced disease at presentation, with erosion of the temporal bone. All patients underwent bony meatoplasty via a postauricular approach to eradicate the disease. Bony meatoplasty was successful in the definitive management of external ear canal cholesteatoma.
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Redaelli de Zinis LO. Spontaneous posterior wall external canal cholesteatoma. EAR, NOSE & THROAT JOURNAL 2012; 90:298-300. [PMID: 21792794 DOI: 10.1177/014556131109000703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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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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External auditory canal cholesteatoma: reassessment of and amendments to its categorization, pathogenesis, and treatment in 34 patients. Otol Neurotol 2009; 29:941-8. [PMID: 18758389 DOI: 10.1097/mao.0b013e318185fb20] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE External auditory canal cholesteatoma (EACC) is a rarity. Although there have been numerous case reports, there are only few systematic analyses of case series, and the pathogenesis of idiopathic EACC remains enigmatic. STUDY DESIGN In a tertiary referral center for a population of 1.5 million inhabitants, 34 patients with 35 EACC (13 idiopathic [1 bilateral] and 22 secondary) who were treated between 1994 and 2006 were included in the study. RESULTS EACC cardinal symptoms were longstanding otorrhea (65%) and dull otalgia (12%). Focal bone destruction in the external auditory canal with retained squamous debris and an intact tympanic membrane were characteristic. Only 27% of the patients showed conductive hearing loss exceeding 20 dB. Patients with idiopathic EACC had lesions typically located on the floor of the external auditory canal and were older, and the mean smoking intensity was also greater (p < 0.05) compared with patients with secondary EACC. The secondary lesions were assigned to categories (poststenotic [n = 6], postoperative [n = 6], and posttraumatic EACC [n = 4]) and rare categories (radiogenic [n = 2], postinflammatory [n = 1], and postobstructive EACC [n = 1]). In addition, we describe 2 patients with EACC secondary to the complete remission of a Langerhans cell histiocytosis of the external auditory canal. Thirty of 34 patients were treated surgically and became all free of recurrence, even after extensive disease. DISCUSSION For the development of idiopathic EACC, repeated microtrauma (e.g., microtrauma resulting from cotton-tipped applicator abuse or from hearing aids) and diminished microcirculation (e.g., from smoking) might be risk factors. A location other than in the inferior portion of the external auditory canal indicates a secondary form of the disease, as in the case of 2 patients with atypically located EACC after years of complete remission of Langerhans cell histiocytosis, which we consider as a new posttumorous category and specific late complication of this rare disease.
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