Foreign body of middle ear masquerading cholesteatoma

Abstract

introductionCholesteatoma is a nightmare for the otologist, whose excision needs a high level of surgical expertise and skill. Its pathogenesis has been debated in depth in the past. This includes theories such as metaplasia, invagination, migration, hyperplasia, etc. [1,2] Foreign body (FB) of external auditory canal (EAC) is a well-known entity in pediatric age group. However, there are very few instances of middle ear FB. PubMed search engine yielded no results for cholesteatoma developing following an FB in the middle ear. Here we are reporting a case of multiple FB in an 18-year-old male who presented to us with foul smelling ear discharge and earache. On examination granulation, polyp was seen occluding the EAC. He did not respond to any oral antibiotics. He was taken up for middle ear and mastoid exploration surgery. During which multiple FB was seen within the middle ear. Extraction of FB revealed the cholesteatoma sac in the middle ear and mastoid. Patient was treated by canal wall down mastoidectomy with tympanoplasty. Here, we are emphasizing the role of FB of middle ear in the development of extensive cholesteatoma in this patient. cAse reportAn 18-year-old male presented to us with the chief complaint of throbbing type of right earache since 5 days. It was ABstrAct Garag, et al.: Foreign body of middle ear masquerading cholesteatoma

A child’s mysterious ear

“…In the case reported by Garag et al a foreign body i.e., plastic electrical cap embedded in granulation tissue and polyp from the middle ear and was removed by surgical exploration with final histopathology consistent with foreign body granuloma. 5 This case had similar presentation like our case except for the intraoperative findings which is unique for our case.…”

An unusual case of ear mould impression material as a foreign body in the middle ear: case report

“…4 A case of a neglected foreign body in the middle ear that triggered the formation of cholesteatoma and acute mastoiditis was reported by Garag et al . 5 Similarly, a case of a bullet in the external auditory canal was reported by Piromchai et al ., where the bullet was pushed through the tympanic membrane into the hypotympanum during an attempt to remove the foreign body. The patient was later referred to an otolaryngologist and the bullet removed by a post-auricular approach.…”

“…Usmani et al reported a case of a vegetative foreign body in external auditory canal that had migrated to the middle ear after multiple attempts of inadvertent removal by a local physician, causing tympanic membrane perforation and facial nerve palsy. 4 A case of a neglected foreign body in the middle ear that triggered the formation of cholesteatoma and acute mastoiditis was reported by Garag et al 5 Similarly, a case of a bullet in the external auditory canal was reported by Piromchai et al, where the bullet was pushed through the tympanic membrane into the hypotympanum during an attempt to remove the foreign body. The patient was later referred to an otolaryngologist and the bullet removed by a post-auricular approach.…”