Cholesteatoma of the external auditory canal in an immunocompromised patient.

A 54-year-old man with human immunodeficiency virus infection presented to our office with an 8-week history of progressively worsening pain in his right ear and an associated decrease in hearing. His symptoms began after he had instilled hydrogen peroxide in the external auditory canal. There was no history of otorrhea, bleeding, vertigo, or facial nerve palsy. The patient habitually used cotton-tipped probes and admitted to traumatizing the outer ear canal on occasion.

Examination revealed that the ear canal was severely impacted with cerumen; the wax was removed with suctioning under magnification. Once the cerumen plug had been removed, a mobile segment of dead bone from the tympanic plate was encountered (figure). The segment was embedded in squamous epithelial debris. Restraint was exercised in extracting this segment of bone because of its proximity to the facial nerve. The patient was treated with antibiotic drops in preparation for surgery. Three diagnoses were entertained: cholesteatoma of the external auditory canal, squamous cell carcinoma, and malignant otitis externa.

Computed tomography demonstrated a soft-tissue lesion in close proximity to the mastoid segment of the facial nerve. The lesion had eroded the confines of the bony canal and abutted on the temporomandibular joint capsule.

After a diagnosis of cholesteatoma of the external auditory canal was established, the lesion was excised and dead bone was drilled away until healthy bone was reached. The defect was reconstructed with a modification of the Palva flap and lined with a split-thickness skin graft. The patient's recovery was uneventful.

Infection of a previously traumatized bony external auditory canal may contribute to the pathogenesis of a cholesteatoma. (1)

Reference

(1.) Gadre AK, Gadre KC. Cholesteatoma of the external auditory canal in hemifacial hypertrophy (hyperplasia). J Laryngol Otol 1989;103:74-8.

Arun K. Gadre, MD; Jennifer Davies, MD

From the Department of Otolaryngology--Head and Neck Surgery, The University of Texas Health Science Center at Houston.