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Demir BT, Akduman D, Bilecenoğlu B, Orhan K. Evaluation of the Sigmoid Sinus Morphology by Cone Beam Computed Tomography; Touchstone of the Posterior Cranial Fossa. World Neurosurg 2024; 183:e127-e135. [PMID: 38043743 DOI: 10.1016/j.wneu.2023.11.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE In this study, we aimed to analyze the relationship of the sigmoid sinus (SS) with the external auditory canal, facial nerve, and mastoid cells from an anatomic point of view, to define the position of the SS during transmastoid, translabyrinthine, retrosigmoid (lateral suboccipital) approaches, in tympanomastoidectomy and posterior cranial fossa surgery. METHODS In this study, the morphologic structures associated with the sigmoid sinus were evaluated in cone beam computed tomography images taken between 2015 and 2022. The images of 68 men and 106 women, aged 18-65 years, obtained from the archive of Ankara University Faculty of Dentistry, Department of Oral and Maxillofacial Radiology were analyzed. RESULTS The most common SS pattern was type II, with a rate of 60.8% (n = 209); the second was type III, with 20.6% (n = 71); and the least common was type I, with 18.6% (n = 64). Although the distance between the horizontal line passing through the external auditory canal and facial nerve and the anterior contour of the SS was highest in type I (right, 7.26 ± 1.62; left, 7.44 ± 0.97), it was lowest in type III (right, 4.40 ± 1.50; left, 4.84 ± 1.16) (P < 0.05). CONCLUSIONS This study highlights the importance of the SS position in surgery, with special reference to otologic, neurotologic, and posterior cranial fossa surgery. To avoid intraoperative complications, each patient should be evaluated preoperatively by appropriate radiologic methods.
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Affiliation(s)
- Berin Tuğtağ Demir
- Department of Anatomy, Faculty of Medicine, Ankara Medipol University, Ankara, Turkey.
| | - Davut Akduman
- Department of Otorhinolaryngology, Gulhane Faculty of Medicine, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Burak Bilecenoğlu
- Department of Anatomy, Faculty of Medicine, Ankara Medipol University, Ankara, Turkey
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
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MacDonald WW, Wakely PE, Kalmar JR, Argyris PP. Fungal Otitis Externa (Otomycosis) Associated with Aspergillus Flavus: A Case Image. Head Neck Pathol 2024; 18:5. [PMID: 38334859 PMCID: PMC10858010 DOI: 10.1007/s12105-023-01606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 02/10/2024]
Abstract
A 48-year-old man presented with a chief complaint of intermittent right ear otorrhea of several-month duration, occasional otalgia and progressive unilateral hearing impairment. He also reported frequent episodes of headache and pressure in the sinuses and maxilla. Previous systemic treatment with antibiotics failed to alleviate the symptoms. A head/neck CT showed completely normal mastoid, middle ear and external auditory canal regions without any evidence of opacification or bone erosion. Otoscopic examination of the right ear disclosed aggregates of dried, brown, fibrillar material and debris occluding the external auditory canal and obstructing the otherwise intact tympanic membrane. Dilation of the external auditory canal or thickening of the tympanic membrane were not appreciated. The canal was debrided and the fibrillar material was placed in formalin. Histopathologic examination revealed numerous branching, septated fungal hyphae organized in densely-packed clusters. In other areas, the fungal hyphae abutted or were attached to lamellated collections of orthokeratin. As highlighted by GMS staining, the fungi were morphologically compatible with Aspergillus species. The clinicopathologic findings supported a diagnosis of fungal otitis externa, while the numerous anucleate squamous cells were compatible with colonization of an underlying, probably developing, cholesteatoma. Culture of material isolated from the external auditory canal confirmed the presence of Aspergillus flavus. In this illustrative case, we present the main clinical and microscopic characteristics of Aspergillus-related otomycosis developing in the setting of a tautochronous cholesteatoma.
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Affiliation(s)
- William W MacDonald
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - John R Kalmar
- Division of Oral and Maxillofacial Pathology, The Ohio State University College of Dentistry, Postle Hall, Room 2191 305 W. 12th Ave, Columbus, OH, USA
| | - Prokopios P Argyris
- Division of Oral and Maxillofacial Pathology, The Ohio State University College of Dentistry, Postle Hall, Room 2191 305 W. 12th Ave, Columbus, OH, USA.
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Rashid KNA, Zainon IH, Othman NAN. Inverted Follicular Keratosis: A Rare Presentation in External Ear Canal. Indian J Otolaryngol Head Neck Surg 2024; 76:1244-1246. [PMID: 38440449 PMCID: PMC10908669 DOI: 10.1007/s12070-023-04241-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/21/2023] [Indexed: 03/06/2024] Open
Abstract
Inverted follicular keratosis is a benign skin lesion that typically presents as an asymptomatic, solitary nodule that may mimic malignant lesions, especially squamous cell carcinoma, both clinically and pathologically. It is developed from the hair follicle infundibulum and can be considered a variant of seborrheic dermatitis. We present a case of a 26-year-old gentleman with a soft tissue mass at the external auditory canal which was later confirmed as inverted follicular keratosis and was treated by endoscopic transcanal excision of the mass with temporalis fascia graft reconstruction. He is currently under surveillance follow-up with no symptoms and signs of recurrence.
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Affiliation(s)
- Khairul Naimah Abdul Rashid
- Department of Otorhinolaryngology Hospital Sultanah Bahiyah, Alor Setar, Kedah Malaysia
- Department of Otorhinolaryngology–Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan 16150 Malaysia
| | - Izny Hafiz Zainon
- Department of Otorhinolaryngology Hospital Sultanah Bahiyah, Alor Setar, Kedah Malaysia
| | - Nik Adilah Nik Othman
- Department of Otorhinolaryngology–Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan 16150 Malaysia
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Rodríguez-Rodero A, Machuca-Aguado J, Aguilar-Vera F, García-Escudero A. Xanthogranuloma in the External Auditory Canal in Childhood, an Unexpected Lesion. Indian J Otolaryngol Head Neck Surg 2024; 76:1098-1100. [PMID: 38440505 PMCID: PMC10908902 DOI: 10.1007/s12070-023-04139-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/11/2023] [Indexed: 03/06/2024] Open
Abstract
Pedunculated lesions in the external auditory canal present a broad differential diagnosis. It is crucial to rule out malignant neoplasms and consider the possibility of xanthogranulomas, which are very rare in this location. Management is determined by associated complications, and otolaryngologists must consider this for appropriate treatment.
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Affiliation(s)
| | - Jesús Machuca-Aguado
- Pathology Department, Virgen Macarena University Hospital, 41009 Avda. Fedriani, 3, Seville, Spain
| | | | - Antonio García-Escudero
- Pathology Department, Virgen Macarena University Hospital, 41009 Avda. Fedriani, 3, Seville, Spain
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Noy R, Livneh I, Naroditsky I, Vaisbuch Y. Lytic Mastoid Lesion in a Patient with Otalgia. Head Neck Pathol 2023; 17:1064-1066. [PMID: 37735288 PMCID: PMC10739648 DOI: 10.1007/s12105-023-01583-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/28/2023] [Indexed: 09/23/2023]
Abstract
The differential diagnosis for an isolated lytic mastoid lesion is broad, encompassing various conditions requiring careful consideration. These include granulomatous disorders such as Langerhans cell histiocytosis and sarcoidosis, neoplastic processes like multiple myeloma, leukemia, lymphoma, and metastases, primary bone diseases such as Paget's disease, fibrous dysplasia, and osteitis fibrosa cystica, as well as infectious causes like osteomyelitis. In this report, we present a patient with otalgia and an isolated lytic mastoid lesion.
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Affiliation(s)
- Roee Noy
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel.
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Ido Livneh
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Department of Pathology, Rambam Health Care Campus, Haifa, Israel
| | - Inna Naroditsky
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Department of Pathology, Rambam Health Care Campus, Haifa, Israel
| | - Yona Vaisbuch
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Saha KL. Surgical Treatment of the Solitary Fibrous Tumour/ Haemangiopericytoma of the External Auditory Canal: A Case Report. Indian J Otolaryngol Head Neck Surg 2023; 75:4098-4100. [PMID: 37974739 PMCID: PMC10645716 DOI: 10.1007/s12070-023-04091-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/23/2023] [Indexed: 11/19/2023] Open
Abstract
A solitary fibrous tumour (SFT)/haemangiopericytoma (HPC) accounts for approximately 1% of all vascular tumours, and 13-25% of them are present in the head and neck region. Here, a case of SFT in the left EAC has been reported with the longest duration follow-up among the previously reported cases.
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Affiliation(s)
- Kanu Lal Saha
- Department of Otolaryngology-Head and Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, 1000 Dhaka Bangladesh
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Varghese SS, Kumar N, Philipose R. Lateral Stenosis of External Auditory Canal Secondary to Corrosive acid Injury: A Rare Case Report and Review of Literature. Indian J Otolaryngol Head Neck Surg 2023; 75:3889-3894. [PMID: 37974851 PMCID: PMC10645683 DOI: 10.1007/s12070-023-03941-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/06/2023] [Indexed: 11/19/2023] Open
Abstract
Acquired external auditory canal (EAC) stenosis is an uncommon condition with an incidence of 0.6 in 100,000 population. Road traffic accidents and otology surgeries are the frequently reported causes for it to occur. The high rate of restenosis makes this condition difficult to manage. A 50 year old lady presented with history of accidental instillation of acid in her left ear at 6 months of age by the care giver. The patient developed stenosis of left EAC with hearing loss. Examination revealed pin point stenosis of left EAC. Puretone audiogram revealed a moderately severe conductive hearing loss. Computed tomogram showed soft tissue lesion obliterating the entire EAC and extending into the middle ear and antrum. Intra operatively only the cartilaginous EAC was stenosed. Surgical excision of the fibrotic scar with a tympanomastoidectomy and wide meatoplasty was done. Regular post operative aural toileting, packing with merocele strips and application of topical antibiotic -steroid preparations was done. 6 months post-surgery a patent EAC and healed tympanic membrane was achieved. In this report, we present a rare case of lateral EAC stenosis secondary to corrosive acid injury, highlighting the surgical steps, post operative care and surgical outcomes. A limited review of literature is also presented.
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Affiliation(s)
| | - Navneet Kumar
- Department of E.N.T, Chrisitan medical college, Ludhiana, Punjab India
| | - Rebecca Philipose
- Department of E.N.T, Chrisitan medical college, Ludhiana, Punjab India
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Hanson MB, Adams M. Follow the Wax: The Natural Protection of the Ear Canal and Its Biome. Otolaryngol Clin North Am 2023; 56:863-867. [PMID: 37517877 DOI: 10.1016/j.otc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
The external canal is a unique environment that has an elaborate mechanism for self-cleaning and protection. The fundamental basis of this is the epithelial migration of the desquamating layers of the keratinizing epithelium that lines the entire canal and ear drum. This migratory movement results in a "conveyor belt" effect where the dead skin is moved out of the bony ear canal to the cartilaginous portion, where it is lifted off with the help of glandular skin secretions and the hairs of the canal to form what we call "ear wax." The ear wax has numerous protective properties and is essential to the health of the external ear. The protective properties are due to chemical properties of the wax, in addition to intrinsic chemical secretions by the sebaceous and cerumen apocrine glands. The protection also comes from a diverse population of organisms that exist in the external ear that are usually saprophytic, commensal, and symbiotic, but in some cases, they can become parasitic and pathologic. Detection and quantification of the members of this biome has been difficult, and their overall role in the normal biome of the ear and their transition into pathogens remain an area of active research and investigation.
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Affiliation(s)
- Matthew B Hanson
- Department of Otolaryngology, SUNY, SUNY Downstate College of Medicine, Kings County Hospital Center, 450 Clarkson Avenue, PO Box 126, Brooklyn, NY 11203, USA.
| | - Matthew Adams
- Resident Physician, Departmentof Otolaryngology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203, USA
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Abstract
Primary EAC neoplasms include benign and malignant lesions of bony, glandular or cutaneous origin. Small, benign slow growing bony neoplasms are often asymptomatic, diagnosed incidentally and might not require intervention. Both malignant and benign neoplasms of cutaneous and glandular origin can present with symptoms of chronic otitis externa, leading to delays in diagnosis. Prompt biopsy of soft tissue lesions associated with non-resolving otitis externa are warranted. Local and regional imaging is helpful to understand disease extent and origin, but even early-stage malignant neoplasms require aggressive surgical treatment.
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Affiliation(s)
- Mallory Raymond
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Florida, 4500 San Sablo Drive, Jacksonville, FL 32224, USA.
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10
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Brooks KA, Gross JH. Radiotherapy-induced Pathology of the Ear. Otolaryngol Clin North Am 2023; 56:977-985. [PMID: 37414656 DOI: 10.1016/j.otc.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Acute radiotherapy (RT)-induced external ear soft tissue changes start with erythema and dry desquamation and may progress to moist desquamation and epidermal ulceration. Chronic RT-induced changes include epithelial atrophy and subcutaneous fibrosis. Although RT-induced radiation dermatitis has been well studied, interventions for soft tissue disease involving the external auditory canal (EAC) warrant investigation. Medical management includes topical steroid treatment for EAC radiation dermatitis and topical antibiotic therapy for suppurative otitis externa. Hyperbaric oxygen and pentoxifylline-vitamin E therapy have shown promise for other applications, but their clinical effect on soft tissue EAC disease is currently undefined.
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Affiliation(s)
- Kaitlyn A Brooks
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA 30308, USA
| | - Jennifer H Gross
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA 30308, USA.
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Curry SD, Maxwell AK. Management of Foreign Bodies in the Ear Canal. Otolaryngol Clin North Am 2023; 56:881-889. [PMID: 37516654 DOI: 10.1016/j.otc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
Using the appropriate instruments and techniques for removing a foreign body from the external auditory canal facilitates the procedure and reduces the risk of complications. Most ear foreign bodies can be addressed on a nonurgent basis, but batteries and caustic materials warrant prompt removal. Referral to an otolaryngologist should be considered for difficult cases or after a failed attempt.
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Affiliation(s)
- Steven D Curry
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, 981225 Nebraska Medical Center, Omaha, NE 68198-1225, USA
| | - Anne K Maxwell
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, 981225 Nebraska Medical Center, Omaha, NE 68198-1225, USA.
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12
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Dosemane D, Khadilkar MN, Parvathareddy N. Modified-modified radical mastoidectomy. Eur Arch Otorhinolaryngol 2023; 280:3897-3900. [PMID: 37195344 PMCID: PMC10313839 DOI: 10.1007/s00405-023-08021-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 05/08/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE It is unusual to have communication from the external auditory canal (EAC) directly to the mastoid, totally sparing the tympanum. These patients need a different surgical approach, a modified canal wall-down procedure, to completely clear the disease but fully preserve the tympanum. We present one such exceptional case. CASE PRESENTATION A 28-year-old lady presented with ear discharge for 1 year. Imaging confirmed the canal-mastoid fistula, but the entire tympanum was normal. We performed a modified-modified radical mastoidectomy. CONCLUSIONS Canal-mastoid fistula is an infrequent entity and may be idiopathic. Despite being evident on clinical examination, imaging aids in assessing size and location of the defect. Although EAC reconstruction may be attempted, the majority require a canal wall-down procedure.
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Affiliation(s)
- Deviprasad Dosemane
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, 575001, India
| | - Meera Niranjan Khadilkar
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, 575001, India.
| | - Navya Parvathareddy
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, 575001, India
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Kanagamuthu P, Dhanasekaran B, Karthika SR, Raghavan VK. To Determine the PH of External Auditory Canal in Otitis Externa: A Prospective Observational Study in a Tertiary Health Care Centre. Indian J Otolaryngol Head Neck Surg 2023; 75:502-506. [PMID: 37206809 PMCID: PMC10188749 DOI: 10.1007/s12070-023-03591-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
Otitis externa is an inflammatory condition of the external auditory canal which occurs due to any trauma, changes in the PH of the skin of external auditory canal. The normal PH of the external auditory canal skin should be in the acidic medium. This inhibits the growth of certain infectious microorganisms. Once the external canal skin PH becomes alkaline, the chances of inflammation of the skin increases. To assess the pH of the external auditory canal in cases of otitis externa with secretion and compare the treatment efficacy of treating it with topical anti-inflammatory like ichthammol glycerine, topical steroid cream and oral antibiotics. A prospective observational study involved a total of 120 patients who came with symptoms and signs of external otitis. pH of external canal was measured during first visit and at 42 days. The patients were divided into three groups. First group was treated with Ichthammol glycerine, second group was treated with Ichthammol glycerine with topical steroid cream and third group was treated with oral antibiotics with topical steroid cream. Patients were analyzed based on severity score during first visit, at 7 days, at 21 days and 42 days. This study involved 64(53.3%) patients were male and 56(46.7%) were females. The mean age group involved in the study was 42.50 years. The mean PH value in the external auditory canal during the first visit was alkaline (6.09) and the mean PH value at 42 days was changed to acidic (4.95) which was statistically significant (p = 0.00). There was significant reduction in the severity score in the oral antibiotic with topical steroid cream, followed by IG with topical steroid cream followed by Ichthammol glycerine (p = 0.001). In this study we have analyzed the pH level favorable in causing otitis externa and the best available treatment for the same. It has been observed that the alkaline Ph is more favorable in causing otitis externa. Efficacy of Topical corticosteroid with antibiotics is maximum in the management of otitis externa.
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Affiliation(s)
- Priya Kanagamuthu
- Present Address: Department of Otorhinolaryngology (ENT), Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chettinad Health City, Rajiv Gandhi Salai, Kelambakkam, 603103 TamilNadu India
| | - Balaji Dhanasekaran
- Present Address: Department of Otorhinolaryngology (ENT), Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chettinad Health City, Rajiv Gandhi Salai, Kelambakkam, 603103 TamilNadu India
| | - S. R. Karthika
- Present Address: Department of Otorhinolaryngology (ENT), Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chettinad Health City, Rajiv Gandhi Salai, Kelambakkam, 603103 TamilNadu India
| | - V. K. Raghavan
- Present Address: Department of Otorhinolaryngology (ENT), Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chettinad Health City, Rajiv Gandhi Salai, Kelambakkam, 603103 TamilNadu India
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Ahmed S, Kunnumal A, Afreen SS, Hasan Z. Parosteal Osteolipoma in the External Auditory Canal: A Rare Variant of Lipoma. Indian J Otolaryngol Head Neck Surg 2023; 75:66-68. [PMID: 37206855 PMCID: PMC10188843 DOI: 10.1007/s12070-022-03237-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022] Open
Abstract
Osteolipomas are a rare variant of lipomas. We present a case of osteolipoma of external audiotry canal in a 30 year old lady who presented with right sided ear fullness since 2 years. A well circumscribed mass was found arising from right bony external audiotry canal. Computed tomography revealed a calcified lesion measuring 9 × 7 mm in the cartilaginous portion of right external auditory canal. Diagnosis of Osteolipomas was made histologically and patient was treated with simple excision of the mass under local anaesthesia.
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Affiliation(s)
- Saud Ahmed
- Department of Otolaryngology at HBS Hospital, Bengaluru, India
| | - Ayisha Kunnumal
- Department of Otolaryngology at HBS Hospital, Bengaluru, India
| | | | - Zubair Hasan
- Department of Otolaryngology at HBS Hospital, Bengaluru, India
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15
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Yang L, Chen P, Liu Y, Yang J, Zhao S. Clinical manifestations and treatment strategies for congenital aural atresia with temporomandibular joint retroposition: a retrospective study of 30 patients. J Otolaryngol Head Neck Surg 2023; 52:24. [PMID: 36882877 PMCID: PMC9993528 DOI: 10.1186/s40463-022-00615-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/07/2022] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Patients with congenital aural atresia (CAA) can present with concomitant temporomandibular joint (TMJ) retroposition, implying that even with a high Jahrsdoerfer score, canaloplasty and tympanoplasty cannot be performed. Therefore, this study aimed to summarize the clinical manifestations and share our diagnostic and treatment experience of this rare entity, which has not been described previously. METHODS Thirty patients (30 ears) with CAA and TMJ retroposition without maxillofacial dysplasia were included. Diagnosis was based on patient history, physical examination, pure-tone average test results, and temporal bone high-resolution computed tomography (HRCT) findings. Their Jahrsdoerfer scores and interventions were also recorded. RESULTS Twenty-four and six patients among the 30 patients (males, n = 15) had CAA and TMJ retroposition on the right and left sides, respectively. Seventeen ears had a normal auricle; most had an enlarged cavum conchae and a large tragus. Twelve ears had an accessory auricle, and two had a preauricular fistula. All external auditory canals had complete atresia, including four with a shallow concavity and four with a small orifice in the cavum conchae. Temporal bone HRCT revealed poor or undeveloped tympanic temporal bone in the diseased ears, atresia in the external auditory canals, and partial/complete occupation of the mandibular condyle with or without soft tissue. The average Jahrsdoerfer score was 8.17. Thirteen patients opted for different surgeries, three wore a bone-conduction hearing aid, and fourteen chose no intervention. CONCLUSIONS CAA with TMJ retroposition was often unilateral, typically on the right side. Most patients had normal auricles, with an enlarged cavum conchae and a large tragus ("mirror ear"). Even with a high Jahrsdoerfer score, traditional hearing reconstruction surgery could not be performed. Patients can undergo Vibrant Soundbridge or Bonebridge implantation or wear bone-conduction hearing aids to improve hearing levels, or refuse intervention because of mild hearing loss. The TMJ location can be used as a Jahrsdoerfer Grading System supplement for preoperative evaluation.
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Affiliation(s)
- Lin Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Dongjiaominxinag No. 1, Dongcheng District, Beijing, 100730, China
| | - Peiwei Chen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Dongjiaominxinag No. 1, Dongcheng District, Beijing, 100730, China
| | - Yujie Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Dongjiaominxinag No. 1, Dongcheng District, Beijing, 100730, China
| | - Jinsong Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Dongjiaominxinag No. 1, Dongcheng District, Beijing, 100730, China
| | - Shouqin Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Dongjiaominxinag No. 1, Dongcheng District, Beijing, 100730, China.
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Lee JY, Cho YS. Clinical outcome and prognostic factors in adenoid cystic carcinoma of the external auditory canal: proposal for a refined T-stage classification system. Eur Arch Otorhinolaryngol 2023:10.1007/s00405-023-07876-3. [PMID: 36781438 DOI: 10.1007/s00405-023-07876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Although adenoid cystic carcinoma (ACC) of the external auditory canal (EAC) has a different pathophysiology from squamous cell carcinoma, the same staging system is used. The aim of this study was to propose a refined staging system, which is more suitable for ACC of the EAC. METHODS A total of 25 patients who were diagnosed with ACC of the EAC were reviewed. The modified Pittsburgh staging system (mPSS) that is universally used for temporal bone malignancy was refined for ACC (rPSS). The limited (< 0.5 cm) lateral soft tissue involvement was classified as T1 and extensive (≥ 0.5 cm) lateral soft tissue involvement as T2. The disease-free survival rate (DFSR) was assessed in the patients who underwent surgical treatment according to two staging systems; mPSS and rPSS. RESULTS When staging using mPSS, most patients (96.0%, n = 24) were classified as T4. However, when rPSS was used, T1, T2, T3, and T4 stage occupied 36.0% (n = 9), 40.0% (n = 10), 12.0% (n = 3), 12.0% (n = 3), respectively. There was no difference in DFSR according to the T stage using mPSS (p = 0.466). However, when rPSS was used, the DFSR showed significant correlation with the T stage (p = 0.032). CONCLUSIONS Clinical T stage of mPSS was not sufficient to predict survival rate in ACC of the EAC, and we propose that the information on the lateral soft tissue involvement needs to be added to the existing staging system.
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Affiliation(s)
- Jung-Yup Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Yang-Sun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
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Wang P, Zhang H, Zhao J, Qiao H, Ge Y, You Q, Hu S. External auditory canal and middle ear tumors: characterization by morphology and diffusion features on CT and MRI. Eur Arch Otorhinolaryngol 2023; 280:605-11. [PMID: 35842859 DOI: 10.1007/s00405-022-07509-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/13/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To explore the value of morphology and diffusion features on CT and MRI in the characterization of external auditory canal and middle ear tumors (EAMETs). METHODS Forty-seven patients with histologically proved EAMETs (23 benign and 24 malignant) who underwent CT and MRI were retrospectively analyzed in this study. CT and MRI characteristics (including size, shape, signal intensity, border, enhancement degree, and bone changes) and apparent diffusion coefficient (ADC) value were analyzed and compared between benign and malignant EAMETs. Logistic regression, receiver operating characteristic (ROC) curve, and Delong test were performed to assess the diagnostic performance. RESULTS Compared with benign tumors, the malignant EAMETs are characterized by irregular shape, ill-defined border, invasive bone destruction, and intense enhancement (all p < 0.05). There were no significant differences on the size and signal intensity between benign and malignant tumors. The ADC value of malignant tumors were (879.96 ± 201.15) × 10-6 mm2/s, which was significantly lower than benign ones (p < 0.05). Logistic regression demonstrates the presence of ill-defined margin, invasive bone destruction, and low ADC value (≤ 920.33 × 10-6 mm2/s) have significant relationship with malignant EAMETs. The combination of characterization by morphology and diffusion features on CT and MRI can further improve the diagnostic efficiency when compared with morphology and diffusion features alone (both p < 0.05). CONCLUSION Some CT and MRI characteristics are helpful in identifying malignant EAMETs from benign ones (especially ill-defined margin, invasive bone destruction, and low ADC value), and the combination of morphology and diffusion features on CT and MRI has best diagnostic efficiency for discriminating these two entities.
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Chen W, Xu M, Wang Q, Xu R, Chen J, Xu H, Li X. Congenital first branchial cleft anomalies in children: a study of 100 surgical cases and a review of the literature. Eur Arch Otorhinolaryngol 2023; 280:425-33. [PMID: 36040517 DOI: 10.1007/s00405-022-07607-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/10/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate the clinical features and surgical outcomes of pediatric congenital first branchial cleft anomalies (CFBCAs). METHODS We conducted a retrospective analysis of 100 children who were referred to Shanghai Children's Hospital from March 2014 to March 2022 for the treatment of CFBCAs. RESULTS This study included 100 patients (33 males, 67 females) with an average age of 4.0 ± 2.7 years. 64 cases were type I FBCAs and 36 were type II. The main clinical manifestations included having a skin pit or discharge from it (62%), painless masses (5%), mucopurulent otorrhea (8%) and recurrent swelling with pain (90%) in the Pochet's triangle area. 92% had infection histories, 84% had incision and drainage histories, and 18% had surgical histories. 6 cases of tympanic membranous attachment were found by auricular endoscopy. Ultrasonography (US) was 55.6% (30/54) accurate and enhanced CT was 75% (75/100) accurate in diagnosing CFBCAs. We dissected the facial nerve (FN) in 46% cases. Lesions ended in the external auditory canal (EAC) wall in 86 cases. 69 exhibited close relationship with the parotid. The patients were followed up 0.25-8.2 years. 11 had postoperative temporary facial paralysis and all improved within 6 months. 3 had recurrence and they were secondarily successfully retreated. No EAC stenosis were found. CONCLUSIONS CFBCAs often presented with repeated swelling and purulence in Pochet's triangle. CT, US and auricular endoscopy can assist in diagnosis and planning the surgical strategy. Complete excision in non-infection stage as soon as possible is the first choice for the treatment of CFBCAs.
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Mohammed S, Jang SH, Moon IS. Fibrous Dysplasia of Temporal Bone. Indian J Otolaryngol Head Neck Surg 2022; 74:4350-4355. [PMID: 36742801 PMCID: PMC9895677 DOI: 10.1007/s12070-021-03009-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/21/2021] [Indexed: 02/07/2023] Open
Abstract
Fibrous dysplasia of temporal bone is a rare benign bone disease. With the advance in imaging, more cases are likely to get reported and present with less disease severity. Temporal Bone Fibrous dysplasia most commonly affects External Auditory canal resulting in External auditory canal stenosis and Conductive Hearing Loss. Many patients are asymptomatic and rarely require intervention. However, we present 3 different clinical scenarios of Temporal Bone Fibrous Dysplasia and elaborate on clinical course that lead to varied managements for each of them.
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Affiliation(s)
- Safeer Mohammed
- Department of Otorhinolaryngology, Amrita Institute of Medical Sciences, Kochi, India
| | - Seung Hyun Jang
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - In Seok Moon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
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20
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Abstract
Foreign bodies (FB) in the external auditory canal are relative medical emergency. The objective of this study was to describe the types of FB and their complications. Hospital-based descriptive study. This study is done at sub-district hospital Nasirabad (district Ajmer) from period 1 January2016 to 31 May 2020 for period of 3 years 5 months included all patients with foreign body ear. A total of 126 patients were included. All cases were attended by ENT specialist. In our study we concluded that most common incidence is children less than 5 years (63.49%), male:female ratio of 1.33:1, most of the patients present within 24 h of presentation, in maximum cases there is no complications, maximum the foreign body is present in right ear. All cases were attended by ENT specialist. Maximum cases are done in local anaesthesia or no anaesthesia at all, 4 case in light anesthesia and 3 cases referred to nearby higher centre. In this we concluded that foreign body is usually present in less than 5 years of age group. Proper instrumentation and proper skill is required to remove foreign body without any complications.
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Affiliation(s)
- Rashmi Yadav
- Department of Otorhinolaryngology, Head & Neck Surgery, JLN Medical College, A-17 Path No.7 Jamna Nagar, Ajmer Road, Sodala, Ajmer, 302006 India
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21
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Ahmed JM, Kandi S, C.P. T. Foreign Body in External Auditory Canal Masquerading as Middle Ear Polyp. Indian J Otolaryngol Head Neck Surg 2022; 74:3675-3677. [PMID: 36742574 PMCID: PMC9895717 DOI: 10.1007/s12070-021-02404-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/18/2021] [Indexed: 02/07/2023] Open
Abstract
Aural Polyps are usually inflammatory in nature however they may rarely be a manifestation of a more severe disease. Aural Polyps that are resistant to conservative management point towards inflammatory polyp with underlying chronic otitis media.Rarely it may be due to foreign body or neoplastic lesions. We present a case of foreign body in external auditory canal masquerading as a middle ear polyp.
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Affiliation(s)
- J. Mansoor Ahmed
- Department of Otorhinolaryngology - Head and Neck Surgery, Vijayanagar Institute of Medical Sciences, Ballari, Karnataka India
| | - Sourabh Kandi
- Department of Otorhinolaryngology - Head and Neck Surgery, Vijayanagar Institute of Medical Sciences, Ballari, Karnataka India
| | - Thoufeer C.P.
- Department of Otorhinolaryngology - Head and Neck Surgery, Vijayanagar Institute of Medical Sciences, Ballari, Karnataka India
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22
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Malli MNA, Shoukat AM. External Auditory Canal Pleomorphic Adenoma: A Rare Case Presentation. Indian J Otolaryngol Head Neck Surg 2022; 74:4106-4109. [PMID: 36742482 PMCID: PMC9895616 DOI: 10.1007/s12070-021-02862-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023] Open
Abstract
Pleomorphic adenoma originating from the external auditory canal is extremely rare, benign tumor. Ceruminal glands are modified sweat glands of the skin, present in the external auditory canal that may give rise to (a) benign tumors such as ceruminous adenoma, pleomorphic adenoma, and syringocystadenoma papilliferum, or (b) malignant tumors such as ceruminous adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma. We report a case where a 25-year-old woman presented with right aural swelling and otalgia since 1 year. A canal-filling aural mass was noted on clinical examination. Computed tomography imaging showed no intracranial extension or any association with the adjacent parotid gland. Subsequent excision biopsy and histologic examination revealed features suggestive of pleomorphic adenoma. Similar to the pleomorphic adenoma of salivary glands, recurrence or malignant degeneration with cellular atypia and metastasis can occur on rare occasions. Care must be taken to distinguish this from adenoid cystic carcinomas, ceruminous adenocarcinomas, and mucoepidermoid carcinomas.
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Affiliation(s)
| | - Asma Mohd Shoukat
- Department of Otolaryngology and Head & Neck Surgery, Navodaya Medical College, Raichur, Karnataka India
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Reghunadhan P, Upasi AP, Rai KK, Shikha N, Vakil S. A spectrum of auditory canal injuries ensuing from direct or indirect trauma to the temporomandibular joint: A 2-year prospective study. J Craniomaxillofac Surg 2022; 50:S1010-5182(22)00145-7. [PMID: 36244893 DOI: 10.1016/j.jcms.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 09/11/2022] [Accepted: 09/27/2022] [Indexed: 11/21/2022] Open
Abstract
This study aimed to assess various auditory canal injuries in patients with direct or indirect temporomandibular joint (TMJ) trauma, and, in collaboration with an otolaryngologist, evaluate the need for intervention. A prospective study was conducted at the institution. Patients who had sustained trauma to the TMJ were assessed for auditory canal injury through clinical and CT scan examination. All the patients were cross-consulted by an otolaryngologist for diagnosis and eventual management of any auditory canal injury. A close 3-month follow-up was carried out for all patients. Out of 32 cases (64 sides) of TMJ trauma, the following auditory canal injuries were documented: five cases (six sides) with tympanic plate fracture; five cases (five sides) with soft-tissue injury to the EAC; two cases (two sides) with tympanic membrane (TM) perforation; and one case (one side) with external auditory canal (EAC) hematoma (all p < 0.001). Corroborative results for the diagnosis of auditory canal injuries between the oral and maxillofacial surgeon (OMFS) and ENT surgeon were found to be statistically significant (p < 0.001). One case of tympanic membrane perforation required tympanoplasty and the rest were treated by conservative management. No complications were seen after 3 months of follow-up. To conclude, maxillofacial surgeons should perform a thorough bilateral ear examination to rule out any auditory canal injury in all the cases presenting with direct or indirect trauma to the TMJ. Timely management of such injuries should be undertaken by an otolaryngologist before TMJ trauma management to avoid any complications.
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Affiliation(s)
| | | | - Kirthi K Rai
- Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Nirdhum Shikha
- Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Samyak Vakil
- Bapuji Dental College and Hospital, Davangere, Karnataka, India
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Jakovljevic S, Arsovic N, Boricic N, Laketic D, Dudvarski Z. Syringocystadenoma Papilliferum in the External Ear Canal. Arch Iran Med 2022; 25:658-660. [PMID: 37543891 PMCID: PMC10685767 DOI: 10.34172/aim.2022.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 11/06/2021] [Indexed: 08/07/2023]
Abstract
Out of all benign tumors of the ceruminous glands, syringocystadenoma papilliferum is the rarest and represents only 2% of cases. It is an extremely rare benign tumor that originates from modified apocrine sweat glands. The aim of this paper was to present, according to our findings, the 18th case of syringocystadenoma papilliferum in the external auditory canal, with a detailed review of its clinical, radiological and histomorphological characteristics. A 59-year-old man reported to our clinic due to a 5×5 mm papillomatous growth at the entrance to the right external auditory canal. Histopathology indicated, after an excisional biopsy, that it was a syringocystadenoma papilliferum. The resection lines were free of tumor tissue, and the patient has no signs of tumor recurrence. Although rare, it should be considered as a differential diagnosis of lesions in this region. Complete excision is mandatory in order to avoid recurrence and potential malignant alteration.
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Affiliation(s)
- Sasa Jakovljevic
- Clinic of Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Nenad Arsovic
- Clinic of Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Novica Boricic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Pathology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Darko Laketic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zoran Dudvarski
- Clinic of Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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25
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Weksler CW, Heiman E, Weiser G. Removal of external auditory canal foreign bodies in the pediatric emergency department - A retrospective comparison study. Int J Pediatr Otorhinolaryngol 2022; 160:111247. [PMID: 35926383 DOI: 10.1016/j.ijporl.2022.111247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/18/2022] [Accepted: 07/12/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The removal of foreign bodies from the external auditory canal (EAC) is a common cause of referral to the pediatric emergency department (PED). The attempt at removal of foreign bodies can lead to complications ranging from mild canal injuries and through severe inner ear damage. The removal requires knowledge and expertise. Ear, Nose and Throat (ENT) physicians are considered the most qualified to remove these foreign bodies. The decision of when the ENTs need to be involved is debated. METHODS A retrospective analytical comparison study was conducted. The study included all children admitted to the PED for EAC foreign body removal, between the years 2009-2019. RESULTS A total of 333 children were included in the study. The mean age was 6.53 years. Success rate of the procedure on the first attempt performed by pediatricians was 82.4% and when performed by ENT physicians the success rate was 96.1%. However, when those with a previous attempt of removal were removed from the study the success rates of PED physicians were 93.9% and of ENT physicians were 96.8%. CONCLUSION This single center study shows that with correct case evaluation, the PED physician can and should succeed in EAC FB removal with minimal complications and comparable to ENT performance. If a first attempt failed, an ENT consult is warranted.
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Hasani M, Haghnegahdar A, Khojastepour L, Golbahar Haghighi MJ. Determining the existence of the foramen of Huschke in patients with temporomandibular joint disorders using cone beam computed tomography: retrospective cohort study. BMC Med Imaging 2022; 22:145. [PMID: 35963990 PMCID: PMC9375943 DOI: 10.1186/s12880-022-00850-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Foramen of Huschke has been presented as an unusual developmental defect in anteroinferior aspect of external auditory canal. It can be associated with significant otologic complications. The purpose of this study was to determine the association between existence of foramen of Huschke and temporomandibular joint disorders in Cone Beam Computed Tomography (CBCT) images. Methods Of an initial sample of 465 patients, we retrospectively evaluated the CBCT images of 118 individuals with clinical signs and symptoms of temporomandibular joint disorders as case group and 256 individuals as control group. The presence, size and localization of foramen of Huschke were assessed in the axial and corrected sagittal images. The sex and age distribution were determined. Fisher’s exact test, T-test and Pearson’s Chi-square were applied to assess the relationship between foramen of Huschke and temporomandibular joint disorders in the case and control groups considering age and sex. Results The foramen of Huschke prevalence was slightly higher in patients with temporomandibular joint disorders (3.4%) than patients without temporomandibular joint disorders (0.8%). However, the difference was not statistically significant (P = 0.082). foramen of Huschke was found in five females and one male. There was no significant difference between case and control groups considering the age of patients with foramen of Huschke (P = 0.683). There was no significant difference between the case and control groups, considering the right and left ears in distribution of foramen of Huschke (P = 0.099) (P = 0.183). Conclusions Higher prevalence of foramen of Huschke in patients with temporomandibular joint disorders may suggest possible mechanism for temporomandibular joint disorders development that can be affected by presence of foramen of Huschke.
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Affiliation(s)
- Mahvash Hasani
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Science, Shiraz, Iran
| | - Abdolaziz Haghnegahdar
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Science, Shiraz, Iran
| | - Leila Khojastepour
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Science, Shiraz, Iran
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Lee DH, Kim JH, Chung IJ, Lim SC. Metastasis of parotid adenocarcinoma to the external auditory canal. Ear Nose Throat J 2022:1455613221086033. [PMID: 35349775 DOI: 10.1177/01455613221086033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Metastatic carcinoma of the external auditory canal (EAC) is extremely rare. Herein, we report the first case of a patient with metastasis of parotid adenocarcinoma to the EAC. Clinicians should include it in the differential diagnosis of tumors of the EAC. In patients with parotid carcinoma, a physical examination of the entire head and neck, including the EAC, should be performed before surgery.
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Affiliation(s)
- Dong Hoon Lee
- Department of Otolaryngology-Head and Neck Surgery,65722Chonnam National University Medical School & Hwasun Hospital, Hwasun, South Korea
| | - Jo Heon Kim
- Department of Pathology, 65722Chonnam National University Medical School & Hwasun Hospital, Hwasun, South Korea
| | - Ik-Joo Chung
- Department of Internal Medicine, 65722Chonnam National University Medical School & Hwasun Hospital, Hwasun, South Korea
| | - Sang Chul Lim
- Department of Otolaryngology-Head and Neck Surgery,65722Chonnam National University Medical School & Hwasun Hospital, Hwasun, South Korea
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Zhong S, Zuo W. Treatment Strategies for Malignancies of the External Auditory Canal. Curr Treat Options Oncol 2022; 23:43-53. [PMID: 35167009 PMCID: PMC8891096 DOI: 10.1007/s11864-021-00931-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/30/2022]
Abstract
Malignant tumors of the external auditory canal (EAC) are rare tumors in the head and neck. Delayed diagnosis is not uncommon because the symptoms of early tumors are nonspecific. Various surgical and oncological treatment modalities have been reported. Decision-making depends on pathological feature and stage of the lesions, patient’s general condition and preference, and physician’s experience and skill. Radical surgery is widely accepted as the primary treatment of choice. Postoperative radiotherapy is used more often to improve local and regional control of the disease. Chemotherapy is usually recommended for advanced disease, residual disease, and metastasis. Prognosis is affected by multiple factors such as TNM stage, surgical margin, pathological type and differentiation of tumor, involvement of facial nerve, and so on. Although the survival rate is improved significantly over the past several decades with the development of skull base surgery, neuroradiology, anesthesiology, and oncology, it remains challenging to diagnose and treat EAC malignancies due to the rarity, the local anatomical complexity of temporal bone, and the lack of standard TNM staging system.
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Affiliation(s)
- Shixun Zhong
- Department of Otolaryngology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Wenqi Zuo
- Department of Otolaryngology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
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Wang J, He A, Zhu Y, Zhou G, Zhang T. Isolation, culture, and identification of ceruminous gland cells. J Mol Histol 2022; 53:227-237. [PMID: 35113280 DOI: 10.1007/s10735-021-10040-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 10/30/2021] [Indexed: 11/29/2022]
Abstract
External auditory canal (EAC) stenosis or atresia usually requires a skin graft to repair, but due to the lack of a graft containing functional glands, postoperative complications such as infection and eczema are common. The aim of this study was to isolate and characterize seed cells for the construction of tissue engineered EAC skin containing ceruminous gland by isolating and cultivating cells of ceruminous gland. In this study, EAC skin samples were harvested from adult goats for ceruminous gland cell isolation. Cell morphology and proliferation rates, expression of CK7, CK8, CK18, and CK19 (glandular cell specific-markers), and secretion of β-defensin-1, lysozyme, and polysaccharides were evaluated at different passages to verify the presence of ceruminous gland cells and determine whether function and proliferation potential were maintained. Ceruminous glands were successfully isolated and extracted from goat EAC skin. Furthermore, the isolated glandular cells maintained robust proliferation potential, exhibited high expression of CK7, CK8, CK18, and CK19, and vigorously secreted β-defensin-1, lysozyme, and polysaccharides in this culture system. However, expression of glandular cell specific-markers and secretory function gradually declined with increasing passage number, indicating dedifferentiation of the subcultured ceruminous gland cells after five passages. In conclusion, ceruminous glands were successfully isolated, cultured, and expanded from goat EAC skin using the serumcontaining culture system. Importantly, the isolated glandular cells retained robust proliferation potential and maintained their phenotype and function in early passages (P1-P3), indicating the method's potential application for ceruminous gland regeneration.
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Affiliation(s)
- Jun Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC,, University of Science and Technology of China, Hefei, 230001, Anhui, People's Republic of China.,ENT Institute, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
| | - Aijuan He
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital of Fudan University, Shanghai, People's Republic of China
| | - Yaying Zhu
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital of Fudan University, Shanghai, People's Republic of China
| | - Guangdong Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, People's Republic of China
| | - Tianyu Zhang
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital of Fudan University, Shanghai, People's Republic of China. .,Hearing Medicine Key Laboratory, National Health and Family Planning Commission, Shanghai, People's Republic of China. .,ENT Institute, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.
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Barati B, Asadi M, Jahanshahi F. Capillary Hemangioma as an Unexpected Pathology in the External Auditory Canal. Iran J Otorhinolaryngol 2022; 34:63-66. [PMID: 35145938 PMCID: PMC8801013 DOI: 10.22038/ijorl.2021.57157.2966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/13/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Hemangiomas are benign vascular lesions frequently observed in infancy and childhood. CASE REPORT A 14-year-old boy was referred to the hospital with a left-sided ear canal mass and hearing impairment. Otoscopic examination revealed a mass that occluded the canal. The transcanal surgical excision was performed. The mass was dissected from the skin, no bony erosion was noted intraoperatively, and the skin was returned back properly. The histopathological report demonstrated a capillary hemangioma of the external auditory canal. CONCLUSIONS Hemangiomas are relatively common in the head and neck, but rarely detected in the external ear canal and tympanic membrane. Hemangioma of the ear canal may be asymptomatic and accidentally observed. Despite the rarity of the mass, it is important to consider them in the differential diagnosis of external auditory canal masses. The computed tomography and magnetic resonance imaging with gadolinium help to reveal the vascular nature of the mass. Complete surgical excision is the treatment of choice.
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Affiliation(s)
- Behrouz Barati
- Departmentof Otolaryngology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mahboobe Asadi
- Departmentof Otolaryngology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding Author: Department of Otolaryngology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail:
| | - Fatemeh Jahanshahi
- Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Dongol K, Karki UR. Pleomorphic adenoma in the external auditory canal: Arising at an atypical location. SAGE Open Med Case Rep 2021; 9:2050313X211063790. [PMID: 34900261 PMCID: PMC8664305 DOI: 10.1177/2050313x211063790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022] Open
Abstract
Pleomorphic adenoma is a common, benign neoplasm typically located in the major salivary glands. The external auditory canal is an atypical location for a pleomorphic adenoma to originate. Wide surgical excision is essential in cases of pleomorphic adenoma due to its tendency to recur and change into malignancy. We report a case of pleomorphic adenoma emerging in the external auditory canal, which is an atypical location for it to originate. A 23-year-old male presented with swelling and decreased hearing in the left ear for 2 months. On examination, there was a smooth, pink, firm swelling in the cartilaginous part of external auditory canal. Pure tone audiogram and computed tomography of temporal bone were performed. The patient underwent excision biopsy and the diagnosis of pleomorphic adenoma was confirmed after histopathology. Long-term follow-up is recommended as pleomorphic adenoma has the potentiality to recur or transform into malignancy.
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Affiliation(s)
- Kripa Dongol
- Department of Otorhinolaryngology Head and Neck Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Utsav Raj Karki
- Department of Otorhinolaryngology Head and Neck Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Jiang Y, Jiang C, Huang X, Huang J, Shi B, Zhu X, Lin L, Huang L. Associations between condylar fractures and external auditory canal fracture: A 7-year retrospective study. J Craniomaxillofac Surg 2021; 50:140-145. [PMID: 34810109 DOI: 10.1016/j.jcms.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/18/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
The study aimed to investigate whether the incidence rate of external auditory canal (EAC) fracture varies among different clinical types of condylar fracture. A retrospective cohort study was conducted in single hospital of China. Eligible patients diagnosed with mandibular condylar fractures were retrospectively reviewed. Among all patients with condylar fractures (318 cases and 437 sides), 45 cases and 59 sides (59/437 sides, 13.5%) were found with EAC fracture, including 17(17/38, 44.7%) sides of sagittal fracture of condyle (Type I), 21(21/59, 35.6%) sides of intracapsular condylar fracture (Type II), 8 (8/306, 2.6%) sides of condylar neck fracture (Type III), and 6 (6/34, 17.7%) sides of condylar base fracture (Type IV). Type III condylar fracture had a significant lower rate of EAC fracture than all other three types (all p<0.001). Type I condylar fracture had a higher rate of EAC fracture compared to Type IV (p=0.014). The incidence rates of EAC fracture in combined Type I+Type II group (38/97, 39.2%) was significantly higher than Type III (8/306,2.6%, p<0.001) and Type IV (6/34,17.7%, p=0.002). A total of 35 sides (27 patients) with combined fractures were followed up for 6 months after treatment, among whom 11 sides (7 patients) were operated for both fractures simultaneously. Neither EAC stenosis nor hearing loss was observed. Meanwhile, for 24 non-operated ears from 20 patients, all EACs showed different degrees of stenosis. In conclusion, oral and maxillofacial surgeons should pay more attention to EAC fracture combined with condylar fracture, especially for patients diagnosed with condylar head fracture. Maxillofacial fractures should be accompanied by early treatment of EAC fractures, in order to prevent EAC stenosis, hearing loss, and other complications.
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Affiliation(s)
- Yan Jiang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian Province, China
| | - Canyang Jiang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian Province, China
| | - Xiaohong Huang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian Province, China
| | - Jianping Huang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian Province, China
| | - Bin Shi
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian Province, China
| | - Xiaofeng Zhu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian Province, China
| | - Lisong Lin
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian Province, China.
| | - Li Huang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian Province, China.
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Lyutenski S, James P, Bloching M. Piezoelectric canalplasty for exostoses and osteoma. Am J Otolaryngol 2021; 42:103114. [PMID: 34166964 DOI: 10.1016/j.amjoto.2021.103114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/13/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the safety profile and surgical technique for removal of symptomatic exostoses and osteoma of the external auditory canal with a micro-oscillating piezoelectric device. METHOD A chart review was conducted on patients undergoing piezoelectric canalplasty between 2019 and 2021 at tertiary referral hospital. Surgery was performed by two surgeons with varying experience. Bone removal was achieved using both osteotomy and osteoplasty. Postoperative complications, operative time and hearing outcome were evaluated. RESULTS The study comprised 16 patients (16 ears). No major complications occurred. The skin of the auditory canal was completely preserved in all patients without injury to the tympanic membrane. Except for one patient with known noise-induced hearing loss, there was no postoperative deterioration of the bone-conduction threshold more than 10 dB HL at any frequency. The difference of the bone-conduction threshold in pure-tone audiometry (average for 0.5, 1, 2 and 4 kHz) three weeks postoperatively had a median of 0.6 dB ± 5.7. One patient complained of temporary new tinnitus. One patient had prolonged wound healing. Mean operative time was comparable with literature data. CONCLUSION The atraumatic characteristics of the piezoelectric instrument enable low-risk removal of external auditory canal exostoses and osteoma. Through the combination of precise osteotomy and osteoplasty, this novel instrument has the potential to become established in routine canalplasty.
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Shaari AL, Xing MH, Mundi N, Khorsandi AS, Geronemus R, Urken ML. Reconstruction of the external auditory canal: The tragal flap revisited and review of contemporary reconstructive techniques. Am J Otolaryngol 2021; 42:103094. [PMID: 34102581 DOI: 10.1016/j.amjoto.2021.103094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Primary malignancies arising in the external auditory canal (EAC) are rare and usually are treated surgically. We review techniques to reconstruct the EAC following ablative surgery, and introduce a rarely utilized tragal skin flap which has particular advantages for reconstruction of limited anterior EAC defects. METHODS The terms "tragal flap", "external auditory canal", "preauricular tragal flap", "reconstructive techniques" were searched on PubMed and Google Scholar. RESULTS Our review identified one description of a tragal flap to reconstruct the EAC following resection of a malignancy. We add an additional case of a preauricular tragal flap to reconstruct the anterior EAC following resection of a recurrent basal cell carcinoma located in the EAC that led to a circumferential defect. CONCLUSION There are several surgical techniques that can be utilized to reconstruct the EAC. We describe a novel tragal flap used to reconstruct the anterior EAC following resection of a recurrent tumor.
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Lou Z. The outcome and complication of endoscopic removal of pediatric ear foreign body. Int J Pediatr Otorhinolaryngol 2021; 146:110753. [PMID: 33951543 DOI: 10.1016/j.ijporl.2021.110753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/05/2021] [Accepted: 04/26/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the outcome and complications of endoscopic removal of pediatric ear foreign bodies (FBs). METHODS This study was a retrospective chart review of pediatric and adult patients who presented for ear FB removal over a 5-year period. RESULTS In 191 children with ear FBs, 105 (55.0%) of the FBs were in contact with or close to the tympanic membrane (TM). The FB was removed using direct suction with a sucker in 172 (90.1%), a right-angle hook alone in 13 (6.8%), and alligator forceps alone in 6 (3.1%). In total, 34 (17.8%, 34/191) complications were reported; they included complications from the FB itself in 2 (5.9%), from prior attempts at removal by non-specialist otologists in 29 (85.3%), and from attempts by the authors in 3 (8.8%). The complication rate for non-specialist otologists using headlights was significantly higher than that for specialist otologists using endoscopes (29/82, 35.4% vs 3/109, 2.8%, P < 0.001). CONCLUSIONS Most pediatric ear FBs are small and in contact with the TM. The use of an endoscope to assist with foreign body removal may be both safe and effective for pediatric ear FBs.
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Abstract
Facial trauma remains a common reason for visits to the emergency department or urgent care facility. The ear remains susceptible to trauma given its delicate anatomy and position in the maxillofacial region. Understanding the anatomy and recognizing the circumstances regarding the mechanism of injury help dictate treatment. The goals of treatment should remain to restore the physiologic form and function of the ear. Middle ear injuries should also be addressed during the process. Although primary repair remains feasible in most cases, there are instances when delayed and staged reconstruction is necessary to achieve successful results.
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He G, Wei R, Chen L, Hong Y, Li H, Liu P, Xu Y, Zhu Z. Primary external auditory canal cholesteatoma of 301 ears: a single-center study. Eur Arch Otorhinolaryngol 2021. [PMID: 33948680 DOI: 10.1007/s00405-021-06851-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Limited literature exists on primary external auditory canal (EAC) cholesteatoma (EACC). Here, we focus on the clinical features of this rare disease, especially the invasive patterns of lesion progression, through a large population study and present simple and practical staging. METHODS In all, 276 patients (male 99; female 177; mean age 41.3 ± 21 years; ears 301) with primary EACC were retrospectively analyzed. Stage I indicated EACC without bony lesions, stage II indicated invasion confined within EAC, stage III indicated invasion beyond the EAC involving mastoid air cells or tympanic cavity, but within the temporal bone, and stage IV indicated invasion beyond the temporal bone. RESULTS In all, 41, 219, 40, and 1 ear with Stage I, II, III, and IV lesions were found, respectively. Common clinical symptoms were hearing loss (237 ears, 78.7%), otalgia (221 ears, 73.4%), and otorrhea (85 ears, 28.2%). The mean air conduction and air-bone gaps were 45.4 ± 17.9 dB HL and 24.6 ± 15 dB HL, respectively. EACCs were found to invade in all directions of the EAC, with the inferior wall (224 ears, 74.4%) > posterior wall (207 ears, 68.8%) > anterior wall (186 ears, 61.8%) > superior wall (86 ears, 28.6%) invasion; multiwall invasions (207 ears) were common; however, inward invasions into the tympanic cavity were rare. CONCLUSION Primary EACCs occurred mostly in women and often unilaterally invaded multiple bony walls in the lower half of the EAC. The present staging reflects the patterns and severity of lesion progression and may be beneficial in treatment planning.
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Enomoto Y, Tsurusaki Y, Tominaga M, Kobayashi S, Inoue M, Fujita K, Kumaki T, Murakami H, Kurosawa K. A Recurrent Variant in POLR1B, c.3007C>T; p.Arg1003Cys, Associated with Atresia of the External Canal and Microtia in Treacher Collins Syndrome Type 4. Mol Syndromol 2021; 12:127-132. [PMID: 34012383 DOI: 10.1159/000513224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/20/2020] [Indexed: 01/26/2023] Open
Abstract
Treacher Collins syndrome (TCS) is a heterogenous malformation syndrome characterized by a distinct facial appearance including downslanting palpebral fissures, malar hypoplasia, conductive hearing loss, and mandibular hypoplasia. Recently, a new causative gene, POLR1B, encoding DNA-directed RNA polymerase I subunit RPA2, was identified as a fourth type of TCS (TCS4). We describe another patient with TCS4 caused by a recurrent POLR1B variant, c.3007C>T; p.Arg1003Cys. Including our patient, all 4 patients with p.(Arg1003Cys) had atresia of the external auditory canal and microtia. All of the reported pathogenic variants in POLR1B were clustered at only 2 residues. Our patient highlights the genotype-phenotype correlation in TCS4 associated with POLR1B.
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Affiliation(s)
- Yumi Enomoto
- Clinical Research Institute, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yoshinori Tsurusaki
- Clinical Research Institute, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Makiko Tominaga
- Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Shinji Kobayashi
- Department of Plastic and Reconstructive Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Maki Inoue
- Department of Otolaryngology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Kazutoshi Fujita
- Department of Radiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Tatsuro Kumaki
- Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Hiroaki Murakami
- Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Kenji Kurosawa
- Clinical Research Institute, Kanagawa Children's Medical Center, Yokohama, Japan.,Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Japan
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De Greve G, van Dinther J, Vanspauwen R, Youri M, Verstreken M, Zarowski A, Offeciers E. The MO-meatocanalplasty: long-term results in the narrow external auditory canal with recurrent otitis externa or the inability to wear a hearing aid. Eur Arch Otorhinolaryngol 2021; 278:4743-4748. [PMID: 33609177 DOI: 10.1007/s00405-020-06599-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The MO-meatocanalplasty is the oblique modification of the M-meatoplasty. The MO-meatocanalplasty was designed to address the superior quadrants of the meatus and the bony canal without the need for a retro-auricular incision. This retrospective analysis was performed to evaluate the long-term results of the MO-meatocanalplasty in patients with a narrow external auditory canal (EAC) with recurrent otitis externa or in patients unable to wear a hearing aid. METHODS Twenty-two ears in twenty consecutive patients who received a MO-meatocanalplasty for a narrow EAC with recurrent otitis externa or the inability to wear a hearing aid were analysed retrospectively. There were no patients included with any type of previous or planned second stage tympanoplasty procedures. A follow-up period of 3 years was analysed for postoperative recurrent narrowing, the self-cleaning capacity of the EAC, the recurrence of otitis externa, the inability to wear a hearing aid, change in hearing level and for all types of aesthetical complaints. RESULTS The MO-meatocanalplasty procedure was effective in 82% (n = 18). Postoperative recurrent narrowing was detected in 9% (n = 2). Insufficient self-cleaning capacity of the EAC was 9.1% (n = 2). The ability to wear a hearing aid was restored in all patients with the need for a hearing aid. No aesthetical complaints were reported. CONCLUSION The MO-meatocanalplasty is an effective, safe and aesthetical accepted procedure to address the narrow meatus and external auditory canal. With this procedure, there is no need for a retro-auricular incision in order to create a well aerated, dry and self-cleaning EAC in patients with a narrow EAC with recurrent otitis externa or in patient with the inability to wear a hearing aid.
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Affiliation(s)
- Glynnis De Greve
- Department of Otorhinolaryngology and Head and Neck Surgery, Sint-Augustinus Hospital, European Institute for ORL-HNS, Oosterveldlaan 24, 2610, Wilrijk, Antwerp, Belgium
| | - Joost van Dinther
- Department of Otorhinolaryngology and Head and Neck Surgery, Sint-Augustinus Hospital, European Institute for ORL-HNS, Oosterveldlaan 24, 2610, Wilrijk, Antwerp, Belgium.
| | - Robby Vanspauwen
- Department of Otorhinolaryngology and Head and Neck Surgery, Sint-Augustinus Hospital, European Institute for ORL-HNS, Oosterveldlaan 24, 2610, Wilrijk, Antwerp, Belgium
| | - Maryn Youri
- Department of Otorhinolaryngology and Head and Neck Surgery, Sint-Augustinus Hospital, European Institute for ORL-HNS, Oosterveldlaan 24, 2610, Wilrijk, Antwerp, Belgium
| | - Margriet Verstreken
- Department of Otorhinolaryngology and Head and Neck Surgery, Sint-Augustinus Hospital, European Institute for ORL-HNS, Oosterveldlaan 24, 2610, Wilrijk, Antwerp, Belgium
| | - Andrzej Zarowski
- Department of Otorhinolaryngology and Head and Neck Surgery, Sint-Augustinus Hospital, European Institute for ORL-HNS, Oosterveldlaan 24, 2610, Wilrijk, Antwerp, Belgium
| | - Erwin Offeciers
- Department of Otorhinolaryngology and Head and Neck Surgery, Sint-Augustinus Hospital, European Institute for ORL-HNS, Oosterveldlaan 24, 2610, Wilrijk, Antwerp, Belgium
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Lambert C, Marin S, Esvan M, Godey B. Impact of ear protection on occurrence of exostosis in surfers: an observational prospective study of 242 ears. Eur Arch Otorhinolaryngol 2021. [PMID: 33555441 DOI: 10.1007/s00405-021-06609-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 01/05/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE The aim of the study was to investigate the efficacy of ear protection (earplug and surf hood) in preventing the development of external auditory exostosis (EAE) in surfers. METHODS We performed a prospective observational study. Volunteer surfers were recruited from June 2016 to October 2017 on the Brittany coast in France. Each participant filled in a questionnaire and underwent otoscopic digitalized photography to establish the degree of external ear obstruction by two different practitioners. The correlation between the percentage of external ear obstruction and the time spent in water with or without protection was evaluated. Risk factors of EAE were assessed. RESULTS Two hundred and forty-two ears were analysed. The incidence of EAE was 89.96% with an average rate of obstruction of 37.65%. Risk factors for EAE were male sex (p = 0.0005), number of years practicing surf (p < 0.0001) and symptoms of ear obstruction (p = 0.0358). A significant correlation was found between EAE severity and number of hours spent in water without any protection (earplugs or surf hood) (p < 0.0001). No correlation was found between EAE severity and time spent in water with earplugs (p = 0.6711) but a correlation was identified between obstruction and time spent in water with surf hood (p = 0.0358). CONCLUSIONS Wearing earplugs is an effective way to prevent EAE in surfers unlike surf hood.
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Beger O, Vayisoğlu Y, Örs AB, Özdemir DL, Müdüroğlu F, Taghipour P, Dağtekin O, Talas DÜ. Comparison of fetal and adult tympanic membrane sizes: a cadaveric study. Surg Radiol Anat 2021; 43:161-167. [PMID: 33048245 DOI: 10.1007/s00276-020-02593-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/03/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The work aimed to compare fetal and adult tympanic membrane (TM) sizes for understanding dimensional development from intrauterine life to adulthood. METHODS Fifty-six temporal bones (18 fetuses, 10 elderly adults, half male and half female in each group) were included in this study. Using a digital image software, the TM height, width and area were measured. RESULTS The mean area, height and width of the TM in adults were found as 58.84 ± 22.01 mm2, 9.06 ± 1.33 mm, and 8.10 ± 1.43 mm, respectively. Moreover, the mean area, height and width of the TM in fetuses were measured as 47.62 ± 12.57 mm2, 8.22 ± 1.12 mm, and 7.25 ± 1.15 mm, respectively. The TM dimensions were increasing in fetuses between 20-32 weeks of gestation. However, the TM dimension was statistically similar at the 7th month, the 8th month and adult periods. The TM height was greater than its width in fetuses and adults. CONCLUSION The calculated regression equations of the TM parameters in fetuses may be used to estimate its size. The TM size did not change from the 7th gestational month, and thus the membrane reached adult diameter in fetal life. The TM height and width showed a very wide range; therefore, we thought that the 12 mm (the height) × 10 mm (the width) graft might be ideal dimension during the repair of the TM perforations.
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Affiliation(s)
- Orhan Beger
- Department of Anatomy, Faculty of Medicine, Mersin University, Ciftlikkoy Campus, 33343, Mersin, Turkey.
| | - Yusuf Vayisoğlu
- Department of Otorhinolaryngology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Alev Bobuş Örs
- Department of Anatomy, Faculty of Medicine, Mersin University, Ciftlikkoy Campus, 33343, Mersin, Turkey
| | | | - Fatma Müdüroğlu
- Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | | | - Oykut Dağtekin
- Department of Histology and Embryology, Mersin City Hospital, Mersin, Turkey
| | - Derya Ümit Talas
- Department of Otorhinolaryngology, Faculty of Medicine, Mersin University, Mersin, Turkey
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Wu B, Tay JKX, Loh WS, Petersson F. Epithelioid Sarcoma of the External Auditory Canal: An Uncommon Tumor at an Unusual Site and a Brief Overview of the Literature. Head Neck Pathol 2021; 15:1328-1334. [PMID: 33394376 PMCID: PMC8633210 DOI: 10.1007/s12105-020-01275-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/12/2020] [Indexed: 01/01/2023]
Abstract
We present a case (41 years old pregnant female) with epithelioid sarcoma arising in the left external auditory canal. On immunohistochemistry, the tumor cell diffusely expressed cytokeratins and showed patchy expression of ERG and CD34. The neoplastic cells demonstrated uniform loss of INI1-expression. Epithelioid sarcoma arising in the external auditory canal is rare. Awareness that ES may rarely arise at unusual sites is of critical importance in order to apply a broad enough panel in the immunohistochemical study, so a misdiagnosis of carcinoma can be avoided.
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Affiliation(s)
- Bingcheng Wu
- grid.410759.e0000 0004 0451 6143Department of Pathology, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Joshua Kai Xun Tay
- grid.410759.e0000 0004 0451 6143Department of Otolaryngology, National University Health System, Singapore, Singapore
| | - Woei Shyang Loh
- grid.410759.e0000 0004 0451 6143Department of Otolaryngology, National University Health System, Singapore, Singapore
| | - Fredrik Petersson
- grid.410759.e0000 0004 0451 6143Department of Pathology, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
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Kiyokawa Y, Ariizumi Y, Ohno K, Ito T, Kawashima Y, Tsunoda A, Kishimoto S, Asakage T, Tsutsumi T. Indications for and extent of elective neck dissection for lymph node metastasis from external auditory canal carcinoma. Auris Nasus Larynx 2020; 48:745-750. [PMID: 33386189 DOI: 10.1016/j.anl.2020.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/01/2020] [Accepted: 12/16/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES We aim to clarify the frequency of lymph node metastasis of external auditory canal (EAC) carcinoma, including susceptible locations, adequate extent of elective neck dissection, and the relationship between the tumor infiltration site and lymph node metastasis. PATIENTS AND METHODS From 2003 to 2018, 63 patients with EAC carcinoma at Tokyo Medical and Dental University Hospital were enrolled in this study. The T and N stages, locations of clinically positive lymph nodes, prognoses, and anatomic site of tumor infiltration were analyzed after treatment. RESULTS Clinically positive lymph node metastasis (cN+) was detected in 18 patients (28.6%), consisting of T1, T2, T3, and T4 disease in 1 (6%), 2 (22%), 8 (38%), and 7 (41%) patients, respectively. The metastatic locations were at level II in 10 patients, parotid gland nodes in 7, preauricular nodes in 5, level Ib in 3, level Va in 3, level III in 1, and superficial cervical nodes in 1. Neck recurrence was determined in two of 45 patients with clinically negative lymph nodes (cN0), with the metastatic locations being levels II, Ib, and III. Among 18 cN+ cases, neck recurrence was noted in 2 of 9 patients who underwent neck dissection. Neck lesions were found to be manageable in all five patients who underwent docetaxel, cisplatin, 5-fluorouracil, and radiation therapy (TPF-RT). No relationship was noted between the tumor infiltration site and lymph node metastasis among T3/4 canrcinoma patients. CONCLUSIONS Elective neck dissection could be indicated only in T3/4 patients with free flap reconstruction. Levels Ib to III are considered appropriate for elective neck dissection in cN0 cases. Levels Ib to III and Va indicated favorable sites, even in cases with metastasis in the parotid gland or preauricular area. Furthermore, TPF-RT could be a useful option even in cN+ cases.
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Affiliation(s)
- Yusuke Kiyokawa
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan; Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Otolaryngology Head and Neck Surgery, Musashino Red Cross Hospital, Tokyo, Japan.
| | - Yousuke Ariizumi
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuchika Ohno
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taku Ito
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiyuki Kawashima
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsunobu Tsunoda
- Department of Otolaryngology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Seiji Kishimoto
- Department of Head and Neck Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Takahiro Asakage
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Tsutsumi
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
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Isshiki T, Yoshizawa Y, Iimura Y, Fukuda K, Suzuki S, Sato Y, Nagasawa T. [Acute promyelocytic leukemia recurrence diagnosed due to granulocytic sarcoma of the external auditory canal]. Rinsho Ketsueki 2020; 61:1590-1594. [PMID: 33298651 DOI: 10.11406/rinketsu.61.1590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 47-year-old man was diagnosed with acute promyelocytic leukemia (APL) accompanied by pancytopenia and left forearm swelling. Complete remission was achieved with remission induction therapy using all-trans retinoic acid (ATRA), and consolidation therapy was completed. Three months after the treatment, left ear closure was observed, and a mass lesion was found in the left external auditory canal. An initial tumor biopsy only revealed inflammatory cell infiltration. Moreover, the tumor's rebiopsy performed 3 months later revealed MPO-positive and CD68-positive granulocyte infiltration. Furthermore, the rebiopsy revealed 4.9×105 copies/µgRNA of PML/RARα, the patient was diagnosed with locally recurrent APL. A bone marrow examination 2 weeks later confirmed an increase in myeloblasts and promyelocytes for the first time since the confirmation of remission. Therefore, it was diagnosed as bone marrow recurrence. Reinduction therapy using ATRA and arsenic trioxide again led to complete remission, after which autologous peripheral blood stem cell transplantation was performed. Currently, complete remission is being maintained. In this case, the recurrence of the external auditory canal lesion preceded the bone marrow recurrence. Therefore, it is important to note the nonspecific leukemia recurrence patterns of the external auditory canal.
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Affiliation(s)
| | | | | | | | | | - Yuji Sato
- Department of Hematology, Tsukuba Memorial Hospital
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Pandiar D, Aravind S, Nayanar SK, Babu S. Incipient Warthin tumor of intraparotid lymph node in a patient with squamous cell carcinoma of the external auditory canal: An incidental finding. Natl J Maxillofac Surg 2020; 11:113-116. [PMID: 33041588 PMCID: PMC7518491 DOI: 10.4103/njms.njms_46_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/19/2019] [Accepted: 10/18/2019] [Indexed: 11/11/2022] Open
Abstract
The occurrence of intranodal salivary gland neoplasm is uncommon; squamous cell carcinoma (SCC) of the external auditory canal (EAC) is another rare occurrence. Clinically, SCC of EAC presents with symptoms similar to other benign otologic conditions. A case of Stage I SCC in EAC region is presented here in a 60-year-old male patient with incidental intranodal Warthin tumor along with the histological differential diagnosis. The patient is being followed up. There is no evidence of recurrence 1 year and 11 months after surgery.
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Affiliation(s)
- Deepak Pandiar
- Department of Clinical Laboratory Services and Translational Research, Malabar Cancer Center, Thalassery, Kerala, India
| | - Sithara Aravind
- Department of Clinical Laboratory Services and Translational Research, Malabar Cancer Center, Thalassery, Kerala, India
| | - Sangeetha K Nayanar
- Department of Clinical Laboratory Services and Translational Research, Malabar Cancer Center, Thalassery, Kerala, India
| | - Sajith Babu
- Department of Surgical Oncology, Malabar Cancer Center, Thalassery, Kerala, India
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Li CL, Li J, Guo Y, Zhang TY. Measurement method for external auditory canal and clinical application in congenital aural stenosis. Int J Pediatr Otorhinolaryngol 2020; 137:110233. [PMID: 32896348 DOI: 10.1016/j.ijporl.2020.110233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe a measurement method for external auditory canal (EAC), especially in congenital aural stenosis (CAS). METHODS High-resolution CT (HRCT) datasets of CAS were imported into the MIMICS 15.0 software for image processing. We used two methods to evaluate the degree of CAS. One is sagittal reconstruction measurement method, the minor axis of the bony ear canal was measured in each layer using sagittal reconstruction. The other is Matlab procedure calculation, we calculated the midpoint axis values of the EAC in each Frankfurt plane. Finally, we compared the minimum value of each method, and verified the sagittal reconstruction measurement method retrospectively in the CAS cases without cholesteatoma who had undergone meatoplasty. RESULTS Twenty CAS cases were selected using the sagittal reconstruction measurement method and Matlab procedure calculation to evaluate the degree of CAS. The mean age was 9.55 ± 2.85 years old (range: 6-15). The mean degree of CAS was 2.09 ± 0.50 mm by sagittal reconstruction measurement method and 2.03 ± 0.58 mm by Matlab procedure calculation. There were no significant differences in the two groups (t = -1.371, p = 0.186). A total of 94 HRCT datasets were imported into MIMICS for verification. The mean age was 11.66 ± 6.56 years old (range: 6-39). Mean stenosis of EAC at surgery was 2.88 ± 0.93 mm (range: 1-4) by using sagittal reconstruction measurement method. CONCLUSIONS Matlab procedure calculation is precise but relatively complicated and is only for scientific research. The sagittal reconstruction measurement method to calculate the most stenotic part of the bony ear canal is relatively simple and accurate to evaluate the degree of CAS. In cases of CAS without cholesteatoma, the precise measurement was critical for the next consultation.
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Koç A, Kaya S. Prevalence of foramen Huschke: evaluation of the association between mastoid pneumatization volume and the existence of foramen Huschke using cone beam computed tomography. Eur Arch Otorhinolaryngol 2021; 278:791-6. [PMID: 32813172 DOI: 10.1007/s00405-020-06296-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The study examined the association between mastoid pneumatization (MP) volume and the existence of foramen Huschke (FH). METHODS Cone beam computed tomography (CBCT) images of 1117 patients (2234 mastoid regions) were analyzed. The prevalence of FH was calculated. The association of MP volume calculated in 83 patients (48 women, 35 men) with sex, side, and the existence of FH analyzed. T test and Pearson's Chi-square test were used for statistical analyses. RESULTS FH was observed in 223 (20%) patients. FH was unilateral in 141 (63.7%) patients (74 left-sided, 68 right-sided) and bilateral in 81 (36.3%) patients. Six patients with FH had herniation into the external auditory canal. MP volume was significantly greater in females (p = 0.016). Additionally, MP volume was significantly greater in patients having FH (p = 0.009). CONCLUSION It is possible to speculate that the volume of MP, which is in close neighborhood with the external auditory canal, somehow affects the existence of FH located in the tympanic segment.
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Takeda T, Ito T, Onishi I, Yokomura M, Kawashima Y, Fujikawa T, Tsutsumi T. Denosumab-induced osteonecrosis of external auditory canal. Auris Nasus Larynx 2020; 48:1199-1203. [PMID: 32713617 DOI: 10.1016/j.anl.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/28/2020] [Accepted: 07/11/2020] [Indexed: 11/26/2022]
Abstract
Denosumab is the world's first human monoclonal antibody for the treatment of osteoporosis and shares an active pathway with bisphosphonates, strongly suppressing osteoclast activities. This is the first case report describing a possible relationship between the development of osteonecrosis of external auditory canal and denosumab administration. We herein report an 81-year-old woman diagnosed with left osteonecrosis of external auditory canal who had a history of denosumab administration. She underwent left radical mastoidectomy due to being refractory to conservative treatment. No major complications or recurrence were observed in the left ear after surgery, but bone erosion in the right ear has continued to progress slowly despite the cessation of denosumab administration. Otolaryngologists should be aware of the association between osteonecrosis of external auditory canal and denosumab administration and consider performing long-term observation even after cessation.
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Affiliation(s)
- Takamori Takeda
- Department of Otolaryngology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Taku Ito
- Department of Otolaryngology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Iichiroh Onishi
- Department of Comprehensive Pathology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Masaru Yokomura
- Department of Otolaryngology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Yoshiyuki Kawashima
- Department of Otolaryngology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Taro Fujikawa
- Department of Otolaryngology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Takeshi Tsutsumi
- Department of Otolaryngology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
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Xie B, Wang M, Zhang S, Liu Y. Parotidectomy in the management of squamous cell carcinoma of the external auditory canal. Eur Arch Otorhinolaryngol 2020; 278:1355-1364. [PMID: 32651676 DOI: 10.1007/s00405-020-06191-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate optimal approaches for appropriate removal of the parotid gland in the management of squamous cell carcinoma (SCC) of the external auditory canal (EAC) at different tumor stages. METHODS In total, 39 patients with SCC of EAC treated at the Second Affiliated Hospital of Nanchang University between September 2003 and April 2019 were enrolled in this study. All patients underwent lateral temporal bone resection or subtotal temporal bone resection. Total parotidectomy was performed in patients with direct parotid invasion. Superficial parotidectomy was performed in patients with parotid node metastasis and patients with advanced stages without evidence of parotid involvement. RESULTS The mean follow-up period was 68.7 months. Local recurrences or distant metastases occurred in five patients (12.8%). The 5-year overall survival rate was 78.4%. The 5-year survival rate was 100% in early stage (T1 and T2) patients, and 58.9 and 50.0% in patients staged III and IV, respectively. Direct parotid invasion was observed in only advanced-stage patients, while parotid node metastasis was noted in both early and advanced-stage patients preoperatively. There were no significant differences (χ2 = 0.1026; p = 0.749) between different tumor primary locations. However, soft tissue or preauricular organs became vulnerable once the anterior wall was infiltrated or eroded. CONCLUSION Parotid management is important for achieving safer and wider tumor-free margins. Total parotidectomy should be mandatory for all advanced-staged (T3 and T4) patients. An optimal decision for parotid management in early stages depends on the infiltration or erosion of the anterior wall of the EAC.
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Affiliation(s)
- Bingbin Xie
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, Jiangxi Province, China.,Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, 330006, China
| | - Meiqun Wang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, Jiangxi Province, China.,Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, 330006, China
| | - Shaorong Zhang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, Jiangxi Province, China.,Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, 330006, China
| | - Yuehui Liu
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, Jiangxi Province, China. .,Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, 330006, China.
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Inagaki T, Morino T, Takagi R, Yamato M, Koizuka I, Yaguchi Y. Transplantation of autologous oral mucosal epithelial cell sheets inhibits the development of acquired external auditory canal atresia in a rabbit model. Acta Biomater 2020; 110:141-52. [PMID: 32438108 DOI: 10.1016/j.actbio.2020.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 11/23/2022]
Abstract
Acquired external auditory canal atresia is characterized by fibrous tissue formation in the ear canal, hearing loss and chronic otorrhea. Although the disease can be treated surgically, the recurrence rate is high. This study explored whether autologous oral mucosal epithelial cell sheets could be used as a novel therapy for ear canal atresia. We succeeded in generating a rabbit model of acquired external auditory canal atresia by dissecting the skin of the ear canal. Endoscopic and histological findings in this model indicated that atresia developed over a 4-week period and was not inhibited by the placement of polyglycolic acid sheets immediately after skin dissection. By contrast, transplantation of autologous oral mucosal epithelial cell sheets, which had been fabricated by culture on temperature-responsive inserts without a feeder layer, prevented the development of atresia during the 4-week period after skin dissection. Transplantation of autologous epithelial cell sheets after surgical treatment of acquired external auditory canal atresia could be a promising new method to reduce the risk of disease recurrence. STATEMENT OF SIGNIFICANCE: Acquired external auditory canal atresia is characterized by fibrous tissue formation in the ear canal, which leads to hearing loss and chronic otorrhea. Although surgical treatments are available, the recurrence rate is high. In this study, we successfully generated a rabbit model of acquired external auditory canal atresia by dissecting the skin of the ear canal. Furthermore, we utilized this new animal model to investigate whether the transplantation of autologous oral mucosal epithelial cell sheets could be used as a novel therapy for ear canal atresia. Our results raise the possibility that the transplantation of autologous epithelial cell sheets after surgical treatment of ear canal atresia could be a promising new method to reduce the risk of disease recurrence.
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