Cholesteatoma of the external auditory canal: case series study
Abstract Introduction: External auditory canal cholesteatoma (EACC) is a rare entity characterized by the invasion of squamous tissue in the auditory canal, that progresses to bone destruction. Due to the scarcity of published cases of EACC, we have deemed useful this review. Material and methods: Prospective and observational study from the year 2000 to the present in 18 patients clinically diagnosed with EACC in our ORL service. Results: The percentage of men and women is similar, with a mean age at diagnosis of 60 years. The most frequently location was postero-inferior, and in most cases, the origin is primary. Otalgia, otorrhea and subjective hearing loss were the main symptoms, being less common the pruritus and exceptional facial weakness. Overall, the treatment is conservative, but it was necessary surgical treatment on one-third of the patients, performing canaloplasty or mastoidectomy, according to the extent of injuries. Conclusions: Although we do not know the genesis and pathogenic mechanisms responsible of EACC formation and development, the inclusion of keratin between the epithelium and bone, with the participation of the periosteum, seems to be the trigger of this process. The diagnosis is clinical, and its extension determines the use of a local or surgical treatment, which is usually resolutive.
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Anthony PF, Anthony WP. Surgical treatment of external auditory canal cholesteatoma. Laryngoscope. 1982;92: 70-5.
Aymat A, Morgan DW, Henderson J. External acoustic meatus cholesteatoma. ORL J Otorhinolaryngol Relat Spec. 1999;61:158-60.
Belcadhi M, Chahed H, Mani R, Bouzouita K. Therapeutic approaches to complicated cholesteatoma of the external auditory canal: a case of associated facial paresis. Ear Nose Throat J. 2010;89:E1-6.
Chang J, Choi J, Im GJ, Jung HH. Dilute vinegar therapy for the management of spontaneous external auditory canal cholesteatoma. Eur Arch Otorhinolaryngol. 2012;269:481-5. doi: 10.1007/s00405-011-1676-x.
Chawla A, Ezhil Bosco JI, Lim TC, Shenoy JN, Krishnan V. Computed Tomography Features of External Auditory Canal Cholesteatoma: A Pictorial Review. Curr Probl Diagn Radiol. 2015;44:511-6 doi: 10.1067/j.cpradiol.2015.05.001.
Dubach P, Häusler R. External auditory canal cholesteatoma: reassessment of and amendments to its categorization, pathogenesis, and treatment in 34 patients. Otol Neurotol. 2008;29:941-8. doi: 10.1097/MAo.0b013e318185fb20.
Dubach P, Mantokoudis G, Caversaccio M. Ear canal cholesteatoma: metaanalysis of clinical characteristics with update on classification, staging and treatment. Curr Opin Otolaryngol Head Neck Surg. 2010;18: 369-76. doi: 10.1097/MOO.0b013e32833da84e.
Fernández-Pérez A, Fernández-Nogueras FJ, Moreno-León J. Colesteatoma del conducto auditivo externo. Acta Otorrinolaring Esp. 1998;49:60-2.
Hartley C, Birzgalis AR, Hartley RH, Lyons TJ, Farrington WT. External ear canal cholesteatoma. Case report. Ann Otol Rhinol Laryngol. 1995;104:868-70.
Heilbrun ME, Salzman KL, Glastonbury CM, Harnsberger HR, Kennedy RJ, Shelton C. External auditory canal cholesteatoma: clinical and imaging spectrum. AJNR Am J Neuroradiol. 2003;24:751-6.
Hn U, Prasad SC, Russo A, Grinblat G, Sanna M. Cholesteatoma of the External Auditory Canal: Review of Staging and Surgical Strategy. Otol Neurotol. 2018;39:e1026-e1033. doi: 10.1097/MAO.0000000000001972.
Holt JJ. Ear canal cholesteatoma. Laryngoscope. 1992;102:608-13.
Jerbi Omezzine S, Dakkem M, Ben Hmida N, Saidi M, Ben Rhouma K, Driss N, et al. Spontaneous cholesteatoma of the external auditory canal: the utility of CT. Diagn Interv Imaging. 2013;94:438-42. doi: 10.1016/j.diii.2013.01.010.
Kim CW, Baek SH, Lee SH, Kim GW, Cho BK. Clinical characteristics of spontaneous cholesteatoma of the external auditory canal in children comparing with cholesteatoma in adults. Eur Arch Otorhinolaryngol. 2014;271:3179-85. doi: 10.1007/s00405-013-2820-6.
Leong AC, Bowdler DA. Complication of dilute vinegar therapy for external auditory canal cholesteatoma. Eur Arch Otorhinolaryngol. 2012;269:2301. doi: 10.1007/s00405-012-2035-2.
Lin YS. Surgical results of external canal cholesteatoma. Acta Otolaryngol. 2009;129:615-23. doi: 10.1080/00016480801901667.
McCoul ED, Hanson MB. External auditory canal cholesteatoma and keratosis obturans: the role of imaging in preventing facial nerve injury. Ear Nose Throat J. 2011;90:E1-7.
Naiberg J, Berger G, Hawke M. The pathologic features of keratosis obturans and cholesteatoma of the external auditory canal. Arch Otolaryngol. 1984;110:690-3.
Naim R, Linthicum F Jr, Shen T, Bran G, Hormann K. Classification of the external auditory canal cholesteatoma. Laryngoscope. 2005;115:455-60.
Owen HH, Rosborg J, Gaihede M. Cholesteatoma of the external ear canal: etiological factors, symptoms and clinical findings in a series of 48 cases. BMC Ear Nose Throat Disord. 2006;23;6: 16.
Park SY, Jung YH, Oh JH. Clinical characteristics of keratosis obturans and external auditory canal cholesteatoma. Otolaryngol Head Neck Surg. 2015;152:326-30. doi: 10.1177/0194599814559384.
Persaud RA, Hajioff D, Thevasagayam MS, Wareing MJ, Wright A. Keratosis obturans and external ear canal cholesteatoma: how and why we should distinguish between these conditions. Clin Otolaryngol Allied Sci. 2004;29:577-81. Review.
Piepergerdes MC, Kramer BM, Behnke EE. Keratosis obturans and external auditory canal cholesteatoma. Laryngoscope. 1980;90:383-91.
Revadi G, Prepageran N, Raman R, Sharizal TA. Epithelial migration on the external ear canal wall in normal and pathologic ears. Otol Neurotol. 2011;32:504-7. doi: 10.1097/MAO.0b013e31820d97e2.
Sanna M, Sunose H, Mancini F, Russo A, Taibah A, Falcioni M. Middle Ear and Mastoid Microsurgery. 2ª ed. Stuttgart, Germany: Thieme; 2012, 601 p.
Sharon JD, Khwaja SS, Drescher A, Gay H, Chole RA. Osteoradionecrosis of the temporal bone: a case series. Otol Neurotol. 2014;35:1207-17. doi: 10.1097/MAO.0000000000000321.
Shin SH, Shim JH, Lee HK. Classification of external auditory canal cholesteatoma by computed tomography. Clin Exp Otothinolaryngol. 2010;3:24-6.
Shinnabe A, Hara M, Hasegawa M, Matsuzawa S, Kanazawa H, Yoshida N, et al. A comparison of patterns of disease extension in keratosis obturans and external auditory canal cholesteatoma. Otol Neurotol. 2013;34:91-4. doi: 10.1097/MAO.0b013e318277a5c8.
Tos M. Cholesteatoma of the external acoustic canal. En: Manual of middle ear surgery: surgery of the external auditory canal. 1ª ed. Stuttgart; New York: Thieme; 1997;320p.205-209.
Toynbee J. Specimens of molluscum contagiosum developed in the external auditory meatus. Lond Med Gaz. 1850;46:261-4. Citado por, https://scholar.google.com/scholar_lookup?journal=Lond+Med+Gaz&title=Specimens+of+molluscum+contagiosum+developed+in+the+external+auditory+meatus&author=J+Toynbee&volume=46&publication_year=1850&pages=11&
Vallejo-Valdezate LA, Gil-Carcedo LM. Patología del oído externo ocasionada por la alteración en la migración epitelial. Queratosis obturans y colesteatoma. En: Gil-Carcedo LM, Vallejo-Valdezate LM. El oído externo. 1ª ed. Madrid: Ergon; 2001. p. 395-400.
Vrabec JT, Chaljub G. External canal cholesteatoma. Am J Otol. 2000;21:608-14.
Wormald PJ. Surgical management of benign necrotizing otitis externa. J Laryngol Otol. 1994 Feb;108:101-5.
Yu SS, Lee KJ, Lin YS. External auditory canal cholesteatoma in patients given radiotherapy for nasopharyngeal carcinoma. Head Neck. 2015;37:1794-8. doi: 10.1002/hed.23826.
Aymat A, Morgan DW, Henderson J. External acoustic meatus cholesteatoma. ORL J Otorhinolaryngol Relat Spec. 1999;61:158-60.
Belcadhi M, Chahed H, Mani R, Bouzouita K. Therapeutic approaches to complicated cholesteatoma of the external auditory canal: a case of associated facial paresis. Ear Nose Throat J. 2010;89:E1-6.
Chang J, Choi J, Im GJ, Jung HH. Dilute vinegar therapy for the management of spontaneous external auditory canal cholesteatoma. Eur Arch Otorhinolaryngol. 2012;269:481-5. doi: 10.1007/s00405-011-1676-x.
Chawla A, Ezhil Bosco JI, Lim TC, Shenoy JN, Krishnan V. Computed Tomography Features of External Auditory Canal Cholesteatoma: A Pictorial Review. Curr Probl Diagn Radiol. 2015;44:511-6 doi: 10.1067/j.cpradiol.2015.05.001.
Dubach P, Häusler R. External auditory canal cholesteatoma: reassessment of and amendments to its categorization, pathogenesis, and treatment in 34 patients. Otol Neurotol. 2008;29:941-8. doi: 10.1097/MAo.0b013e318185fb20.
Dubach P, Mantokoudis G, Caversaccio M. Ear canal cholesteatoma: metaanalysis of clinical characteristics with update on classification, staging and treatment. Curr Opin Otolaryngol Head Neck Surg. 2010;18: 369-76. doi: 10.1097/MOO.0b013e32833da84e.
Fernández-Pérez A, Fernández-Nogueras FJ, Moreno-León J. Colesteatoma del conducto auditivo externo. Acta Otorrinolaring Esp. 1998;49:60-2.
Hartley C, Birzgalis AR, Hartley RH, Lyons TJ, Farrington WT. External ear canal cholesteatoma. Case report. Ann Otol Rhinol Laryngol. 1995;104:868-70.
Heilbrun ME, Salzman KL, Glastonbury CM, Harnsberger HR, Kennedy RJ, Shelton C. External auditory canal cholesteatoma: clinical and imaging spectrum. AJNR Am J Neuroradiol. 2003;24:751-6.
Hn U, Prasad SC, Russo A, Grinblat G, Sanna M. Cholesteatoma of the External Auditory Canal: Review of Staging and Surgical Strategy. Otol Neurotol. 2018;39:e1026-e1033. doi: 10.1097/MAO.0000000000001972.
Holt JJ. Ear canal cholesteatoma. Laryngoscope. 1992;102:608-13.
Jerbi Omezzine S, Dakkem M, Ben Hmida N, Saidi M, Ben Rhouma K, Driss N, et al. Spontaneous cholesteatoma of the external auditory canal: the utility of CT. Diagn Interv Imaging. 2013;94:438-42. doi: 10.1016/j.diii.2013.01.010.
Kim CW, Baek SH, Lee SH, Kim GW, Cho BK. Clinical characteristics of spontaneous cholesteatoma of the external auditory canal in children comparing with cholesteatoma in adults. Eur Arch Otorhinolaryngol. 2014;271:3179-85. doi: 10.1007/s00405-013-2820-6.
Leong AC, Bowdler DA. Complication of dilute vinegar therapy for external auditory canal cholesteatoma. Eur Arch Otorhinolaryngol. 2012;269:2301. doi: 10.1007/s00405-012-2035-2.
Lin YS. Surgical results of external canal cholesteatoma. Acta Otolaryngol. 2009;129:615-23. doi: 10.1080/00016480801901667.
McCoul ED, Hanson MB. External auditory canal cholesteatoma and keratosis obturans: the role of imaging in preventing facial nerve injury. Ear Nose Throat J. 2011;90:E1-7.
Naiberg J, Berger G, Hawke M. The pathologic features of keratosis obturans and cholesteatoma of the external auditory canal. Arch Otolaryngol. 1984;110:690-3.
Naim R, Linthicum F Jr, Shen T, Bran G, Hormann K. Classification of the external auditory canal cholesteatoma. Laryngoscope. 2005;115:455-60.
Owen HH, Rosborg J, Gaihede M. Cholesteatoma of the external ear canal: etiological factors, symptoms and clinical findings in a series of 48 cases. BMC Ear Nose Throat Disord. 2006;23;6: 16.
Park SY, Jung YH, Oh JH. Clinical characteristics of keratosis obturans and external auditory canal cholesteatoma. Otolaryngol Head Neck Surg. 2015;152:326-30. doi: 10.1177/0194599814559384.
Persaud RA, Hajioff D, Thevasagayam MS, Wareing MJ, Wright A. Keratosis obturans and external ear canal cholesteatoma: how and why we should distinguish between these conditions. Clin Otolaryngol Allied Sci. 2004;29:577-81. Review.
Piepergerdes MC, Kramer BM, Behnke EE. Keratosis obturans and external auditory canal cholesteatoma. Laryngoscope. 1980;90:383-91.
Revadi G, Prepageran N, Raman R, Sharizal TA. Epithelial migration on the external ear canal wall in normal and pathologic ears. Otol Neurotol. 2011;32:504-7. doi: 10.1097/MAO.0b013e31820d97e2.
Sanna M, Sunose H, Mancini F, Russo A, Taibah A, Falcioni M. Middle Ear and Mastoid Microsurgery. 2ª ed. Stuttgart, Germany: Thieme; 2012, 601 p.
Sharon JD, Khwaja SS, Drescher A, Gay H, Chole RA. Osteoradionecrosis of the temporal bone: a case series. Otol Neurotol. 2014;35:1207-17. doi: 10.1097/MAO.0000000000000321.
Shin SH, Shim JH, Lee HK. Classification of external auditory canal cholesteatoma by computed tomography. Clin Exp Otothinolaryngol. 2010;3:24-6.
Shinnabe A, Hara M, Hasegawa M, Matsuzawa S, Kanazawa H, Yoshida N, et al. A comparison of patterns of disease extension in keratosis obturans and external auditory canal cholesteatoma. Otol Neurotol. 2013;34:91-4. doi: 10.1097/MAO.0b013e318277a5c8.
Tos M. Cholesteatoma of the external acoustic canal. En: Manual of middle ear surgery: surgery of the external auditory canal. 1ª ed. Stuttgart; New York: Thieme; 1997;320p.205-209.
Toynbee J. Specimens of molluscum contagiosum developed in the external auditory meatus. Lond Med Gaz. 1850;46:261-4. Citado por, https://scholar.google.com/scholar_lookup?journal=Lond+Med+Gaz&title=Specimens+of+molluscum+contagiosum+developed+in+the+external+auditory+meatus&author=J+Toynbee&volume=46&publication_year=1850&pages=11&
Vallejo-Valdezate LA, Gil-Carcedo LM. Patología del oído externo ocasionada por la alteración en la migración epitelial. Queratosis obturans y colesteatoma. En: Gil-Carcedo LM, Vallejo-Valdezate LM. El oído externo. 1ª ed. Madrid: Ergon; 2001. p. 395-400.
Vrabec JT, Chaljub G. External canal cholesteatoma. Am J Otol. 2000;21:608-14.
Wormald PJ. Surgical management of benign necrotizing otitis externa. J Laryngol Otol. 1994 Feb;108:101-5.
Yu SS, Lee KJ, Lin YS. External auditory canal cholesteatoma in patients given radiotherapy for nasopharyngeal carcinoma. Head Neck. 2015;37:1794-8. doi: 10.1002/hed.23826.
Viveros-Díez, P., Benito-Orejas, J. I., Fernández-Rodríguez, A., Cifuentes-Navas, V. A., Ramírez-Salas, J. E., & Morais-Pérez, D. (2019). Cholesteatoma of the external auditory canal: case series study. Revista ORL, 11(2), 129–138. https://doi.org/10.14201/orl.21649
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