We present a case of cholesteatoma of external auditory canal with invasion to atic, aditus and antrum. Tympanic membrane
remained intact. Malleus, incus and stapes supra structure were absent with dehiscent horizontal segment of facial nerve. Cochlea
was totally dehiscent. Symptoms were only chronic otorrhoea and hearing impairment. Diagnosis was based on clinical analysis. CT
Scan was used to measure pathology. Treatment was Modified radical mastoidectomy associated with meatoplasty.
17 years old female, presented to Otorhinolaryngological
outpatient department of IOM, TUTH with complains of bilateral
ear discharge and bilateral decreased hearing since childhood. She
had a history of right atticotomy with PORP placement 2 years back.
Since then there is no history of discharge from right ear. Otoscopy
showed intact left tympanic membrane with cholesteatoma in
left external auditory canal attached with posterosuperior part
of pars tense and posterior atic. Pure tone audiometry showed
40dB mild conductive hearing loss in right ear and 59dB moderate
conductive hearing loss in left ear. Cholesteatoma of external
canal was suspected and high resolution CT scan of temporal
bone was requested. CT scan showed soft tissue density in left
external auditory canal and left mastoid cavity (Figures 1a & 1b).
Intraoperative observation revealed cholesteatoma in left external
auditory canal, atic, aditus and antrum. Dural plate and semicircular
canal were intact. However sinus plate was exposed, facial nerve
was dehiscent in horizontal segment. Cochlea was totally dehiscent
(Figure2). Regarding ossicular status malleus, incus and stapes
supra structure were totally absent. We conducted Left modified
radical mastoidectomy with meatoplasty.
Cholesteatoma rarely originates from external auditory canal.
External auditory cholesteatoma has a incidence of about 0.1-0.5%
in new patients with ear problems [1-3]. Progression of disease
is slow, thus it is evident especially in elderly people [4,5]. It can
affect adjacent structures (lateral sinus, facial nerve, posterior
cranial fossa). Therefore, a CT scan is recommended for all patients
[1,2,6,7]. Surgery is the treatment of choice, whose main purpose
is to eradicate the lesion and, if possible, preserve the patient’s
hearing acuity .