Spontaneous external auditory canal cholesteatoma in a young male: Imaging findings and differential diagnoses

Abstract

A cholesteatoma is a non-neoplastic lesion of the petrous temporal bone commonly described as “skin in the wrong place.” It typically arises within the middle ear cavity, may drain externally via tympanic membrane (mural type), or may originate in the external auditory canal (EAC). The latter type is rarely encountered and typically affects the elderly. EAC cholesteatoma poses diagnostic challenges because it has numerous differential diagnoses. The present case describes a 19-year-old male who presented with gradually progressive diminution of hearing in a previously naïve right ear since 8 months. A soft tissue attenuation lesion confined to the right EAC with erosion of the canal on computed tomography prompted magnetic resonance imaging (MRI). The lesion showed restricted diffusion on MRI. Thus, a diagnosis of spontaneous EAC cholesteatoma was established. The case elucidates the rarity of spontaneous EAC cholesteatoma in a young male. In addition, it describes the role of imaging to detect, delineate the extent, and characterize lesions of petrous temporal bone. The case also discusses common differential diagnoses of EAC cholesteatoma, as well as the importance of diffusion weighted imaging in EAC cholesteatoma similar to its middle ear counterpart.

Air spaces of the temporal bone: a morphometric analysis with clinical implications

“…The typical location of this disease is the middle ear cavity, and the treatment modalities for EAC cholesteatomas vary and depend on the extent of the involvement. For smaller lesions localized to the EAC, eg, debridement is suggested and for greater lesions , surgery is recommended [6].…”

A case of cholesteatoma in a medieval Hispano‐Mudejar population (13th–14th centuries ad)

“…Cholesteatoma consists of a nonneoplastic and ectopic proliferation of stratified squamous tissue, together with exfoliated keratin (Aswani et al, 2016).…”

“…Cholesteatoma consists of a nonneoplastic and ectopic proliferation of stratified squamous tissue, together with exfoliated keratin (Aswani et al, 2016). It is an otological pathology that generally presents with hearing loss and a purulent and fetid otorrhea that requires frequent cleaning.…”

Skeletal evidence for two external auditory canal disorder cases from medieval China

“…(3) smooth and regular lesion margins. Moreover, if cholesteatoma develops in an inward direction, it may penetrate the tympanic membrane and subsequently involve the tympanum, ossicular chain, and osseous labyrinth of the inner ear (Armentano et al, 2014;Aswani et al, 2016;Yao, 2021). EACC is clinically classified into four stages according to the extent of lesion involvement.…”

“…The symptoms and complications resulting from various ear disorders are generally similar due to the specific anatomy and functionality of the ear. Diseases such as infections and cholesteatoma can lead to otorrhea, defined as the accumulation or outflow of fluid from the EAC (Aswani et al, 2016). An ear infection is accompanied by fever and pain.…”