Article

Classification of the External Auditory Canal Cholesteatoma

Universität Mannheim, Mannheim, Baden-Württemberg, Germany
The Laryngoscope (Impact Factor: 2.14). 04/2005; 115(3):455-60. DOI: 10.1097/01.mlg.0000157847.70907.42
Source: PubMed

ABSTRACT

The external auditory canal cholesteatoma (EACC) is a rare disease in the field of otolaryngology. Only 1 in 1,000 new otologic patients present with this entity, which was first described by Toynbee. The aim of this article is to classify EACC by different histopathologic and clinical findings of patients presenting to the Department of Otolaryngology at the University of Mannheim, Germany.
From 2000 to 2004, 17 patients presented to our clinic with EACC. The cholesteatoma were treated surgically, and the specimens were investigated histologically. Clinical findings were also recorded. We classified four stages: stage I with hyperplasia of the canal epithelium, stage II including periosteitis, Stage III including a defective bony canal, and stage IV showing an erosion of adjacent anatomic structure.
Eight patients presented with stage II, five patients with stage III, three with stage I, and only one patient presented with erosion of the mastoid cells, which was determined as stage IV.
In summary, our classification serves to describe the different histopathologic and clinical stages of EACC.

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    • "In accordance with the histopathological classification suggested by Naim et al. [20], all our cases presented as stage III or IV with osteitis, localized invasion and bony destruction including extensions into adjacent structures in some cases. Hence, less severe cases with hyperplasia and periosteitis only have not been included in our material (stage I and II) [20], but probably treated conservatively by our private otological practises (secondary referral centres). This obviously influences the incidences, and some variations should be expected due to local differences of practice including referral patterns [21]. "
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    ABSTRACT: To evaluate symptoms, clinical findings, and etiological factors in external ear canal cholesteatoma (EECC). Retrospective evaluation of clinical records of all consecutive patients with EECC in the period 1979 to 2005 in a tertiary referral centre. Main outcome measures were incidence rates, classification according to causes, symptoms, extensions in the ear canal including adjacent structures, and possible etiological factors. Forty-five patients were identified with 48 EECC. Overall incidence rate was 0.30 cases per year per 100,000 inhabitants. Twenty-five cases were primary, while 23 cases were secondary: postoperative (n = 9), postinflammatory (n = 5), postirradiatory (n = 7), and posttraumatic (n = 2). Primary EECC showed a right/left ratio of 12/13 and presented with otalgia (n = 15), itching (n = 5), occlusion (n = 4), hearing loss (n = 3), fullness (n = 2), and otorrhea (n = 1). Similar symptoms were found in secondary EECC, but less pronounced. In total the temporomandibular joint was exposed in 11 cases, while the mastoid and middle ear was invaded in six and three cases, respectively. In one primary case the facial nerve was exposed and in a posttraumatic case the atticus and antrum were invaded. In primary EECC 48% of cases reported mechanical trauma. EECC is a rare condition with inconsistent and silent symptoms, whereas the extent of destruction may be pronounced. Otalgia was the predominant symptom and often related to extension into nearby structures. Whereas the aetiology of secondary EECC can be explained, the origin of primary EECC remains uncertain; smoking and minor trauma of the ear canal may predispose.
    Full-text · Article · Feb 2006 · BMC Ear Nose and Throat Disorders
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    ABSTRACT: Cholesteatoma of the EAC is a rare otologic problem, particularly when keratosis obturans otica is excluded. The predominant features of EAC cholesteatoma are acute external symptoms, severe pain, recurrent physician visits, and paucity of X-ray findings. Poorly responding otitis externa should always alert the physician to the possibility of neoplasm, diabetes, or some other underlying condition which will not respond to just topical treatment. Cholesteatoma of the external auditory canal should also be considered in refractory cases of otitis externa. Three patients with EAC subperiosteal cholesteatoma are reviewed.
    Full-text · Article · Sep 1978 · Clinical Otolaryngology
  • [Show abstract] [Hide abstract]
    ABSTRACT: The external auditory canal cholesteatoma (EACC) is a rare disease in the field of otolaryngology. Only 1 in 1,000 new otologic patients present with this entity, which was first described by Toynbee. The aim of this article is to classify EACC by different histopathologic and clinical findings of patients presenting to the Department of Otolaryngology at the University of Mannheim, Germany. From 2000 to 2004, 17 patients presented to our clinic with EACC. The cholesteatoma were treated surgically, and the specimens were investigated histologically. Clinical findings were also recorded. We classified four stages: stage I with hyperplasia of the canal epithelium, stage II including periosteitis, Stage III including a defective bony canal, and stage IV showing an erosion of adjacent anatomic structure. Eight patients presented with stage II, five patients with stage III, three with stage I, and only one patient presented with erosion of the mastoid cells, which was determined as stage IV. In summary, our classification serves to describe the different histopathologic and clinical stages of EACC.
    No preview · Article · Apr 2005 · The Laryngoscope
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