External Cholesteatoma in the ear literature reading

cholesteatoma externa

1. EXTERNAL CHOLESTEATOMA Department Of Otorhinolaryngology Head & Neck Surgery Faculty of Medicine Padjadjaran University Dr. Hasan Sadikin General Hospital Bandung 2024 Presented by: dr. Ayu Niendar Puspita Dewi Supervised by: dr. Arif Dermawan ., Sp.T.H.T.B.K.L., Subsp. A.I (K)., M.Kes Literature Reading

2. Anatomy of External Ear Canal External ear: Pinna External auditory canal (EAC): cartilage(1/3 lateral) and bone (2/3 medial) Christopher J.L., Frank E. L., Disease Of the External Ear. In Bailey BJ. Head & Neck Surgery-Otolaryngology. 5 th ed. Lippincot Williams & Wilkins, Philadelphia. 2014. p.2333-2357

3. Histology of External Ear External auditory canal Junqueira’s Basic Histology 15 th ed. 2018. p.509

4. Definition Shin SH, Shim JH, Lee HK. Classification of external auditory canal cholesteatoma by computed tomography. Clin Exp Otorhinolaryngol . 2010 Mar;3(1):24-6. Dhingra P, Pusalkar AG. Spontaneous External Auditory Canal Cholesteatoma: Case Series and Review of Literature. Indian J Otolaryngol Head Neck Surg. 2019;72(1):86–91.

5. Epidemiology The annual incidence in the general population is of 0.15 cases per 100,000 individuals. Incidence among patient visiting otology clinic : 1/1000 INCIDENCE The mean age: 41.2 years, range (6–75 yr ) Male:female ratio of 1:1.63, 15 (48.3%) were right ears and 16 (51.6%) were left ears. DEMOGRAPHY Dongol K, Shadiyah H, Gyawali BR, Rayamajhi P, Pradhananga RB. External Auditory Canal Cholesteatoma: Clinical and Radiological Features. Int Arch Otorhinolaryngol . 2022;26(2):213–8. Udayabhanu HN, Prasad SC, Russo A, Grinblat G, Sanna M. Cholesteatoma of the external auditory canal: Review of staging and surgical strategy. Otol Neurotol . 2018;39(10):e1026–33. The external cholesteatoma is a very uncommon entity, which was first described by Toynbee in 1850.

6. Etiology Udayabhanu HN, Prasad SC, Russo A, Grinblat G, Sanna M. Cholesteatoma of the external auditory canal: Review of staging and surgical strategy. Otol Neurotol . 2018;39(10):e1026–33. Hertz J, Siim C. External auditory canal cholesteatoma and benign necrotising otitis externa: Clinical study of 95 cases in the Capital Region of Denmark. J Laryngol Otol. 2018;132(6):514–8.

7. Genesis of primary and secondary cholesteatomas Pathogenesis Dhingra PL Anatomy of ear. In: Dhingra PL, ed. Diseases of Ear, Nose and Throat & Head and Neck Surgery. 6th ed. New York: Elsevier; 2018.p.74.

8. Pathogenesis Prevent or slow the normal migration of squamous cells of the external ear canal Build-up of keratin debris Isolate pockets of squamous epithelium or cause canal stenosis Entrapment of squamous epithelial debris Postoperative Cholesteatoma Chawla A, Ezhil Bosco JI, Lim TC, Shenoy JN, Krishnan V. Computed Tomography Features of External Auditory Canal Cholesteatoma: A Pictorial Review. Curr Probl Diagn Radiol . 2015;44(6):511–6.

9. Classification Author Classification Farrior (1990) Due to congenital atresia of CAE and stenosis of CAE Associated with tympanoplasty, middle ear surgery, or trauma of CAE’s skin Associated with keratosis obturans Associated with focal osteitis Holt (1992) Postoperative Posttrauma CAE stenosis (mostly congenital) Secondary external meatus obstruction due to tumor or osteoma Idiopathic Tos (1997) Primer Secondary ( postopetrative , postinfection, and posttrauma ) Associated with congenital CAE atresia Owen (2006) Primer Secondary (postoperative, postinfection, postradiotherapy, and posttrauma )

10. Staging of External Cholesteatoma Naim R, Linthicum F, Shen T, Bran G, Hormann K. Classification of the external auditory canal cholesteatoma. Laryngoscope. 2005;115(3):455–60.

11. Comparison of Naim’s Classification Vs Udayabhanu’s Classification Udayabhanu HN, Prasad SC, Russo A, Grinblat G, Sanna M. Cholesteatoma of the external auditory canal: Review of staging and surgical strategy. Otol Neurotol . 2018;39(10):e1026–33.

12. Staging of External Cholesteatoma Shin SH, Shim JH, Lee HK. Classification of external auditory canal cholesteatoma by computed tomography. Clin Exp Otorhinolaryngol . 2010;3(1):24–6.

13. Clinical Manifestation Lesser THJ. Keratosis Obturans , Primary Auditory Canal Cholesteatoma and Benign Necrotizing Otitis Externa. In: Watkinson JC, Clarke RW,eds . ScottBrown’s Otorhinolaryngology Head & Neck Surgery. Vol 2. Pediatrics The Ear Skull Base. 8th ed. Florida: CRC Press. Taylo and Francis Group; 2018. P.941-46.

14. Clinical Manifestation Udayabhanu HN, Prasad SC, Russo A, Grinblat G, Sanna M. Cholesteatoma of the external auditory canal: Review of staging and surgical strategy. Otol Neurotol . 2018;39(10):e1026–33.

15. Clinical Manifestation A 76-year-old female patient with external auditory canal cholesteatoma. Otoscopic (A) and CT (B) findings demonstrate focal bony erosion of the inferior wall. With regular follow-up, inflammation of the canal skin was resolved without surgery (C). Park SY, Jung YH, Oh JH. Clinical characteristics of keratosis obturans and external auditory canal cholesteatoma. Otolaryngol - Head Neck Surg (United States). 2014;152(2):326–30.

16. Clinical Manifestation Jang CH, Kim YY, Seong JY, Kang SH, Jung EK, Sung CM, et al. Clinical characteristics of pediatric external auditory canal cholesteatoma. Int J Pediatr Otorhinolaryngol . 2016;87:5–10. Otoendoscopy and temporal bone CT show posterior wall destruction with invasion into the mastoid cavity (arrows) on the right side with preservation of scutum (red arrow) (A, B). Postoperative CT shows canal wall reconstruction using bone pate with fibrin glue (arrow; C) which has resulted in incomplete bone regeneration

17. Radiological Findings Heilbrun ME, Salzman KL, Glastonbury CM, Harnsberger HR, Kennedy RJ, Shelton C. External auditory canal cholesteatoma: Clinical and imaging spectrum. Am J Neuroradiol . 2003;24(4):751–6.

18. Radiological Findings Heilbrun ME, Salzman KL, Glastonbury CM, Harnsberger HR, Kennedy RJ, Shelton C. External auditory canal cholesteatoma: Clinical and imaging spectrum. Am J Neuroradiol . 2003;24(4):751–6. Coronal temporal bone CT shows an EACC as a soft-tissue mass in the inferior EAC

19. Radiological Findings Heilbrun ME, Salzman KL, Glastonbury CM, Harnsberger HR, Kennedy RJ, Shelton C. External auditory canal cholesteatoma: Clinical and imaging spectrum. Am J Neuroradiol . 2003;24(4):751–6. External cholesteatoma with extension into the middle ear cavity.

20. Histopathology Cholesteatoma matrix (M) and perimatrix (P) Papillary ingrowth of the epithelium Cholesteatoma pearl showing a thin matrix and perimatrix filled with keratin debris (KD) Florian Hoppe and Michael B. Gluth . Pathophysiology of Cholesteatoma. In: John L. Dorn hoffer , Michael B. Gluth . The Chronic ear. Thieme . 2016.p20

21. Diagnosis Lesser THJ. Keratosis Obturans , Primary Auditory Canal Cholesteatoma and Benign Necrotizing Otitis Externa. In: Watkinson JC, Clarke RW,eds . ScottBrown’s Otorhinolaryngology Head & Neck Surgery. Vol 2. Pediatrics The Ear Skull Base. 8th ed. Florida: CRC Press. Taylo and Francis Group; 2018. P.941-46.

22. Differential Diagnosis Lesser THJ. Keratosis Obturans , Primary Auditory Canal Cholesteatoma and Benign Necrotizing Otitis Externa. In: Watkinson JC, Clarke RW,eds . ScottBrown’s Otorhinolaryngology Head & Neck Surgery. Vol 2. Pediatrics The Ear Skull Base. 8th ed. Florida: CRC Press. Taylo and Francis Group; 2018. P.941-46.

23. Complications due to extensive expansion into the mastoid

24. Treatment

25. Treatment Shin SH, Shim JH, Lee HK. Classification of external auditory canal cholesteatoma by computed tomography. Clin Exp Otorhinolaryngol . 2010;3(1):24–6.

26. C onclusion

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