Bilateral ossification of the auricles: an unusual entity and review of the literature

Abstract

BackgroundTrue ossification of the auricle with cartilage replacement by bone, is a very rare clinical entity and can result in an entirely rigid auricle.Case presentationWe present a rare case of bilateral ossification of the auricles in a 75-years old man with profound progressive rigidity of both auricles. His main complaint was a mild discomfort during resting making sleeping unpleasant without any other serious symptoms. His medical history was significant for predisposing factors for this condition such as, Addison's disease and diabetes mellitus. Excisional biopsy was performed confirming the ossified nature of the auricles. Further treatment deemed unnecessary in our case due to his mild clinical picture.ConclusionTrue auricular ossification is a quite rare clinical entity with unclear pathogenesis and one should have in mind that there is always the possibility of a serious co-existed disease like endocrinopathy.

Petrified ear

“…Nevertheless, such changes rarely can occur in the auricular cartilage and have been described by various terms such as dystrophic or metastatic calcification and heterotopic or ectopic ossification. [2] The systemic illness most often related with calcification of auricular cartilage is suprarenal insufficiency. One of the aetiological hypotheses posed is that the acute or chronic shortage of cortisol may produce a long-lasting or transient hypercalcaemia that favors the deposits of calcium in tissues.…”

Petrified auricle with ectopic ossification and trans- epidermal elimination of bone sequester: A case story and review of the literature

“…Ectopic ossification of the auricle is a rare cause of petrified ear and a phenomenon in which the normal elastic cartilage is transformed into lamellar bone [1,3,9,16] . Ectopic ossification appears either as part of rare syndromes characterized by abnormal de novo ossification (primary ossification) e.g.…”

“…The latter is more common and has been described in connection with cold exposure or frost bite, trauma, inflammation in and around some cutaneous neoplasms (e.g. pilomatrixoma, chondroid syringoma and nevi) [15] (see Table 1) and in some systemic metabolic/endocrine diseases [3,6,9,14,17,20] , some of which are associated with hypercalcemia [19] (see Tables 1, 2). Petrified auricle with irreversible hardening of the elastic cartilage was first described in 1866 by Bochdalek et al [23] , and…”

“…after calcium gluconate therapy [26] or idiopathic calcification (unknown underlying cause). Ectopic tissue calcification, including ossification of the auricle, has been described in connection with systemic disorders such as diabetes mellitus and Addison disease (see Tables 1, 2) [9,10,17] . However, there is no evidence that calcification progresses to ossification, and ossified auricle should not necessarily prompt investigations for underlying conditions [4] , although laboratory/biochemical evaluation may be helpful in identifying particularly calcifying disorders.…”

Bilateral Ossification of the Auricular Cartilage

“…Some patients present pain on pressure and, in a few cases, pressure ulcers may develop. 4 In addition, alterations of the external auditory canal can lead to secondary otalgia and hearing impairment. The rigidity is most commonly bilateral and progressive.…”