Polyp of the external auditory canal with two attachments. (Otoscopic Clinic).

The figure shows four views (A-D) of a benign granulation-tissue polyp within the right external auditory canal of an 18-year-old man with acute otitis externa who had been unsuccessfully treated with 3 weeks of oral antibiotics for an earache in his right ear.

Views A and B show the initial appearance: a cylindrical red mass of granulation tissue crossing diagonally from an attachment at the 10 o'clock position to the 4 o'clock position, near the lateral end of the bony canal. The granulation tissue was detached from each end and removed.

View C shows the otoscopic view immediately after the polypoid tissue was removed but before the ear canal skin at each source of the polyp had been cauterized with silver nitrate. The tympanic membrane is intact and does not appear to be involved by otitis media.

View D shows the polyp, measuring 7 mm in length. The patient was treated with a topical antibiotic and steroid otic drops, which brought about complete resolution and a return to normal.

Acute or chronic otitis externa is a condition for which the treatment is topical, involving both cleansing and medication. It is only the unusual case with simultaneous acute otitis media or significant cellulitis and generalized toxicity in which systemic antibiotics are also indicated.