Aural Polyp is not Always Due to Chronic Otitis Media (COM): Preoperative Computed Tomographic Scan is Good Pointer for Sinister Lesions

Abstract

Twenty five patients of aural polyp who underwent canal wall down mastoidectomy were analysed retrospectively. Histopathological examination revealed cholesteatoma in 22 (88%) patients. However, histopathological diagnosis in 3 of these patients was unusual and rare benign tumors of the middle ear cleft-meningioma, neurilemmoma and capillary hemangioma. Review of the preoperative High Resolution Computed Tomography (HRCT) temporal bone revealed an unusual picture in all of the three cases. Features noted were: widening of the jugular foramen (meningioma), destruction of the anterior wall of mesotympanum (neurilemmoma), enhancing soft tissue density lesion (capillary hemangioma). Further, there was only partial loss of pneumatisation of the mastoid air cells in all of the 3 cases. It was observed that though HRCT temporal bone is a commonly advised investigation in patients of chronic otitis media (COM) with aural polyp, meticulous interpretation may reveal unusual features pointing towards sinister diagnosis. Conclusion: Aural polyp with preservation of pneumatisation of mastoid air cells points towards diagnosis other than COM.

Aural polyps: What's behind them?

“…The prevalence of cholesteatoma obtained in this study was 58%, which is in accordance with Milroy et al (9), López Aguado et al (10), and Arroyo Gargallo et al (11) who observed prevalence of cholesteatoma in patients with polyps of 43.7%, 50%, and 52%, respectively. Other authors, such as Xenellis et al (7) and Kalra et al(2) obtained a higher prevalence of cholesteatomas: 86.7% and 88%, respectively. All these studies were retrospective and subject to several biases inherent to the nature of this study design.…”

“…It was also possible to determine that polyps were not associated with greater involvement of the facial nerve, since it was only involved in 6 (7.4%) cases in this sample, and in 4 of them, the underlying disease was a neoplasm. This sign was also associated with malignancy according to Xenellis et al (7) and also had a low prevalence according to Kalra et al (2).…”

A Clinicopathological Study of Aural Polyps: A Retrospective Analysis in a Tertiary Care Hospital

“…Tegmen erosion can happen secondary to any extensive squamous disease, due to underlying inflammatory or malignant pathology, trauma, and/or brain herniation 7,9,10 . In our study, the brain herniation presented as an aural polyp.…”