External auditory canal polyp.

A 63-year-old man complained of a 2-month history of chronic discharge from his left ear. He was a habitual user of cotton swabs, and he cleaned his ears daily. In addition to the otorrhea, he occasionally noticed blood on the swabs.

Examination revealed the presence of a friable polyp on the floor of the ear canal (figure). The tympanic membrane was intact. The 512-Hz tuning fork test showed lateralization to the left ear, and air conduction was greater than bone conduction in both ears.

[FIGURE OMITTED]

The differential diagnosis included an inflammatory polyp or a malignant growth. The patient was initially started on ototopical antibiotic/steroid drops three times daily and asked to return in 7 to 10 days. At the return visit, the condition of the mass was unchanged. A biopsy was performed in the office and submitted for pathology. In addition, high-resolution computed tomography (CT) of the temporal bone was ordered. The biopsy analysis identified a squamous cell carcinoma. CT detected no bony erosion.

The patient underwent a lateral temporal bone resection, which included resection of the external bony canal, the tympanic membrane, the malleus, and the incus. The ear canal was sutured closed.

The prognosis in this case was excellent. Even when a lesion is small, it is advisable to be aggressive in the surgical resection in order to achieve a cure. There is a high incidence of recurrence with local resection only. In the case described here, the patient's follow-up included periodic magnetic resonance imaging, and he exhibited no evidence of recurrence.

John W. House, MD; Jose N. Fayad, MD From the House Ear Clinic and the Keck School of Medicine, University of South California, Los Angeles.