Colesteatoma del conducto auditivo externo: Experiencia de 5 años Hospital del Salvador / External ear canal cholesteatoma: 5-year experience Hospital del Salvador

Introducción: El colesteatoma del conducto auditivo externo (CCAE) es una estructura quística revestida por epitelio escamoso estratificado queratinizado que tiene la capacidad de invadir y erosionar localmente al hueso temporal. Su incidencia es de 0,19 a 0,3/100.000 habitantes siendo 60 veces menos frecuente que el de oído medio. Objetivo: Describir las características epidemiológicas, clínicas, imagenológicas y tratamiento de los pacientes diagnosticados con CCAE en el Servicio de Otorrinolaringología Hospital del Salvador. Material y Método: Se presenta una serie de ocho casos clínicos recopilados durante el período 2017 y 2021. Se realizó revisión de fichas clínicas, biopsias y tomografías computadas de oídos (TC oídos). Se describen los hallazgos y tratamiento efectuado. Resultados: El promedio de edad fue de 65,6 años, correspondiente a 5 mujeres y 3 hombres con presencia de tabaquismo y diabetes en la mitad de los casos. Los síntomas y signos más frecuentes fueron otalgia e hipoacusia seguido de otorrea. 7 pacientes se presentaron con tímpano íntegro y el compromiso de la pared inferior del conducto se evidenció en 6 de 8 pacientes. La TC oídos mostró erosión ósea del conducto, con o sin compromiso de estructuras adyacentes, en todos los casos y el diagnóstico histológico fue efectuado en el 100% de los pacientes. Se privilegió el tratamiento conservador mediante curaciones óticas periódicas asociado a ácido salicílico al 3% y/o antibióticos tópicos en 6/8 pacientes. Conclusiones: El CCAE es una entidad poco frecuente sin signos ni síntomas patognomónicos por lo que el diagnóstico histológico junto con el estudio imagenológico es perentorio. El tratamiento conservador es una alternativa terapéutica válida que ofrece buenos resultados en pacientes con adecuada adherencia al tratamiento y posibilidad de seguimiento estricto.

Introduction: External ear canal cholesteatoma (EECC) is a cystic structure lined by keratinized stratified squamous epithelium that has the ability to locally invade and erode the temporal bone. Its incidence is 0.19 to 0.3 / 100,000 habitants, being 60 times less frequent than that of the middle ear. Aim: To describe the epidemiological, clinical, imaging and treatment characteristics of patients diagnosed with EECC in the Hospital del Salvador ENT department. Material and Methods: A series of eight clinical cases collected during the period 2017 and 2021 is presented. A review of clinical records, biopsies and computed tomography of the ear (ear CT) was carried out. The findings and treatment carried out are described. Results: The average age was 65.6 years corresponding to 5 women and 3 men with the presence of smoking and diabetes in half of the cases. The most frequent symptoms and signs were earache and hearing loss followed by otorrhea. 7 patients presented with an intact eardrum and compromise of the inferior wall of the canal was evidenced in 6 of 8 patients. Ears CT showed bone erosion of the canal with or without compromise of adjacent structures in all cases and the histological diagnosis was made in 100% of the patients. Conservative treatment with periodic ear dressings associated with 3% salicylic acid and / or topical antibiotics was favored in 6/8 patients. Conclusion: EECC is a rare entity without pathognomonic signs or symptoms, therefore the histological diagnosis together with the imaging study is peremptory. Conservative treatment is a valid therapeutic alternative that offers good results in patients with adequate adherence to treatment and the possibility of strict follow-up.

Quiste epidermoide en conducto auditivo externo: reporte de caso / Epidermoid cysts of the external auditory canal: case report

Resumen El quiste epidérmico es una lesión benigna y común de la piel. Se desarrolla por un bloqueo de la unidad pilosebácea, con la consecuente proliferación de células epiteliales y secuestro de queratina. El 7% se desarrollan en cabeza y cuello, sin embargo, son infrecuentes en canal auditivo externo. Su patrón de crecimiento es lento y progresivo durante años, siendo asintomáticos. Al aumentar de tamaño causan sintomatología variable, acorde a su localización; en el canal auditivo tienen un comportamiento obstructivo que genera síntomas como otalgia e hipoacusia. Se presenta caso de una paciente de 69 años, con acúfeno e hipoacusia progresiva derecha. Durante la otoscopia se observó una neoformación obstructiva del 100% de la luz del conducto. Se realizaron estudios de imagen que reportaron tumoración de características quísticas de conducto auditivo derecho, bien circunscrita, sin erosión ósea. Para el diagnóstico definitivo, se realizó resección quirúrgica y biopsia reportando quiste epidérmico. Durante el seguimiento posoperatorio sin hallazgos de recidiva.

Abstract The epidermal cyst is a common and benign lesion of the skin. It develops due to a blockage of the pilosebaceous unit, with the consequent proliferation of epithelial cells and keratin sequestration. Seven percent develop in the head and neck; however, they are infrequent in the external auditory canal. Its growth pattern is slow and progressive over the years, being asymptomatic. As they increase in size, they cause variable symptoms, according to their location. In the ear canal they have an obstructive behavior that generates symptoms such as earache and hearing loss. A case of a 69-year-old female with tinnitus and progressive right hearing loss is presented. At otoscopy, a 100% obstructive neoformation of the canal lumen was observed. Imaging studies showed a well circumscribed, cystic tumor of the right ear canal, without bone erosion. For the definitive diagnosis, a resection and biopsy were performed, reporting an epidermal cyst. During follow up there was no recurrence of tumor.

A Case of Contrast Enhanced Cystic Mass of External Ear Canal Diagnosed as Engorged Hard Tick

A 58-year-old female complained earfullness and otalgia and came to the clinic. Dark gray colored cystic mass obstructing the left ear canal was observed during the endoscopic exam. Contrast enhanced CT image showed an oval shape soft tissue lesion in the mid part of the external auditory canal with a homogenous increased contrast uptake. The mass was removed under microscopic view at outpatient clinic. While dissecting the mass in the ear canal, a pod like structure was visualized. The external organism was densely adherent to the skin and turned out to be an engorged hard tick. Considering the final diagnosis, contrast uptake observed in the CT scan implicates the patient communication of blood between host and parasite. This unique image finding differs from a benign mass lesion in the ear canal was one of the differential diagnosis points for the lesion. This article is reporting the case of tick bite in the ear canal with a rare CT scan finding.

Myxoid Neurofibromas of the External Ear Canal: A Case Report

Myxoid neurofibroma is benign tumours of perineural cell origin that arise from elements in the peripheral nervous system. We report a case of a 60-year-old female patient presented with history of right ear mass which was slowly growing. Her primary complaint was cosmetic deformity but hearing loss was also present. The mass was excised and histologically revealed a myxoid neurofibroma. To the authors’ knowledge, this is the first time that a myxoid neurofibroma arising from external auditory canal is reported. It should be included in the differential diagnosis of a mass originating from this location.

Associação entre Mycoplasma spp. e ácaros do conduto auditivo de bovinos / Mycoplasmas species associated with the ear mites in cattle

Esse estudo foi realizado com o objetivo de verificar a associação entre micoplasmas e ácaros (Raillietia auris e R. flechtmanni) no conduto auditivo de bovinos. Foram realizadas lavagens no conduto auditivo externo de 60 bovinos abatidos no Estado do Rio de Janeiro, Brasil. Para a lavagem dos condutos auditivos foi utilizada solução salina tamponada (PBS, pH 7.2) em seringas estéreis de 60mL. Para o isolamento de micoplasmas foram utilizados pools de ácaros por animal, lavados sucessivamente em 1mL de meio Hayflick modificado. Os lavados dos ácaros foram diluídos de 10-1 até 10-5 e repicados em meio Hayflick modificado, sólido e líquido e incubados a 37°C por 48-72 horas em microaerofilia. A identificação das espécies de micoplasmas foi realizada pelo teste da imunoperoxidase indireta (IPI). Verificou-se alta prevalência de ácaros do gênero Raillietia spp. 76,7% (46/60). O parasitismo por ácaros e micoplasmas foi verificado em 40 animais (74,1%), sendo esta associação significativa (p<0,001). Dos ácaros processados para isolamento de micoplasmas, 193 foram fêmeas e 25 machos. A frequência de Mycoplasma em Raillietia spp. foi de 81,2% (177/218) (p<0.001). Das fêmeas identificadas, 52,3% (101/193) foram R. auris e 47,7% (92/193) R. flechtmanni. A frequência de Mycoplasma nas fêmeas de R. auris foi de 75,2% (76/101) e na espécie R. flechtmanni foi de 88% (81/92) (P<0.05). As espécies de micoplasmas tipificadas pela IPI nos ácaros Raillietia auris foram: M. alkalescens 6,9%, M. arginini 3,4%, M. bovirhinis 9,2%, M. conjunctivae 18,4%, M. mycoides mycoides LC 8,0%, M. capricolum 5,7%. Em R. flechtmanni as espécies de micoplasmas identificadas foram: M. alkalescens 12,2%, M. arginini 1,0%, M. bovirhinis 18,9%, M. bovis 2,2%, M. conjunctivae 21,0%, M. mycoides mycoides LC 11,0% e M. capricolum 4,4%. As espécies de micoplasmas identificadas no conduto auditivo externo dos bovinos foram as mesmas presentes nos ácaros R. auris e R. flechtmanni. Os resultados confirmam que o conduto auditivo externo de bovinos é um habitat de Mycoplasma spp., incluindo espécies potencialmente patogênicas para os rebanhos, além dos ácaros R. auris e R. flechtmanni estarem associados com esses molicutes carreando-os em seu organismo.

This study was carried out to assess the association between of mycoplasmas species with ear mites Raillietia auris and R. flechtmanni in the external ear canal of 60 bovines at slaughter time from the State of Rio de Janeiro, Brazil. Steril syringes (60ml) loaded with buffer solution (PBS, pH 7.2) were used for the ear canal flushing. Were processed 218 mites for mycoplasma isolation. A pool of mites from each sampled bovine was washed five times sucessively in 1mL of liquid modified Hayflick´s medium. The washed mites obtained were diluted up to 10-1 at 10-5, inoculated in liquid and solid Hayflick´s media and incubated at 37ºC for 2-3 days, being the plates put into jar for the obtention of microaerofilia condition. The Typical colonies were typified by the indirect imunoperoxidase test (IPI) with paper discs satured with hyperimmune rabbit sera. In the studied bovine high prevalence was verified Raillietia spp. 76.7% (46/60). The parasitism by mycoplasmas and mites was verified in 40 animals (74.1%), this association was significant (p<0.001). Among the mites processed for isolation mycoplasmas 193 were female and 25 males. The frequency of Mycoplasma in Raillietia spp. was of 81.2% (177/218) (p<0.001). Of the females identified 52.3% (101/193) were R. auris and 47.7% (92/193) were R. flechtmanni. The frequency of Mycoplasma in the females of R. auris was of 75.2% (76/101) and 88% (81/92) in R. flechtmanni (P<0.05). The mycoplasmas species typified by IPI in the Raillietia auris mites were M. alkalescens 6.9%, M. arginini 3.4%, M. bovirhinis 9.2%, M. conjunctivae 18.4%, M. mycoides mycoides LC 8.0%, M. capricolum 5.7%. In the R. flechtmanni mites mycoplasmas species typified were M. alkalescens 12.2%, M. arginini 1.0%, M. bovirhinis 18.9%, M. bovis 2.2%, M. conjunctivae 21.0%, M. mycoides mycoides LC 11.0% e M. capricolum 4.4%. The species of identified mycoplasmas in the external ear canal bovine and mites were exactly the same. The results confirm that the external ear canal cattle's ear canal is also a mycoplasmas source, including potentially pathogenic species for cattle, and these mollicutes are closely related with mites Raillietia spp. that is carrier and this agent in your organism.

Avaliação ultrassonográfica do meato acústico em cães / Ultrasonographic evaluation of the external ear in dogs

O propósito deste trabalho foi determinar a viabilidade da ultrassonografia para avaliar o canal auditivo externo de cães, aferindo a espessura e arquitetura da parede do conduto auditivo e bula timpânica. Foram avaliados 10 cães da raça Retriever do Labrador não portadores de otite externa. O exame foi realizado com o aparelho de ultrassonografia bidimensional e transdutor linear de 14 MHz, com todos os animais sob efeito de anestesia geral. O exame foi efetivado antes e depois do conduto ser preenchido com solução salina, promovendo uma janela acústica anecóica. A artéria maxilar foi identificada com o Doppler colorido o que facilitou a localização da bula timpânica em todos os cães. A definição da imagem da parede proximal ao transdutor foi pior quando comparada à parede distal em todos os animais, isto devido à proximidade da parede com a face de leitura do transdutor. Nos cães que apresentavam uma maior quantidade de cerúmen a superfície do epitélio estava com uma camada hiperecóica mais evidente. A membrana timpânica não foi identificada em nenhum animal. Conclui-se que ultrassonografia é viável e deve ser mais pesquisada na contribuição diagnóstica das doenças óticas em cães.

The purpose of this study was to determine the viability of ultrasonographic evaluation of the external ear in dogs. The thickness and architecture of the ear wall and tympanic bulla of 10 Labrador Retrievers without ear disease was evaluated. The examination was performed with an ultrasound system and a 14 MHz bidimentional linear-array transducer and general anesthesia, before and after the infusion of saline solution into the ear canal. The maxillary artery was identified with color Doppler and helped to establish the location of the tympanic bulla in all dogs. The proximal wall was less well-defined when compared with the distal wall of the ear canal. Dogs with increased ceruminal content within the ear canal showed a hypoechoic epithelium. The tympanic membrane was not identified. It was concluded that ultrasound evaluation is feasible and needs to be explored as clinical diagnostic tool for the diagnosis of ear diseases in dogs.

Potentially pathogenic mycoplasmas in the external ear canal of clinically normal cattle in Southeast Brazil: first report / Micoplasmas potencialmente patogênicos no canal auditivo de bovinos clinicamente sadios no Sul do Brasil: primeiro relato

Mycoplasmas were searched in the ear canal flushing of 60 bovine in Brazil. The prevalence obtained was 80 percent. The percentages of typified species were 12.5 percent, for M. alkalenses; 2.1 percent, M. arginini; 8.35 percent, M. bovirhinis; 2.1 percent, M. bovis; 25.0 percent, M. conjunctivae; 14.6 percent, M. mycoides subsp. mycoides LC and 10.4 percent M. capricolum.

Foram pesquisados micoplasmas no conduto auditivo de 60 bovinos no Brasil. A prevalência obtida foi de 80 por cento. A porcentagem das espécies tipificadas foi de M. alkalenses, 12,5 por cento; M. arginini, 2,1 por cento; M. bovirhinis, 8,35 por cento; M. bovis, 2,1 por cento; M. conjunctivae, 25,0 por cento; M. mycoides subsp. mycoides LC, 14,6 por cento e M. capricolum, 10,4 por cento.

The Study on Incidence of Pityrosporosis of the External Ear Canal between Normal Persons and Patients with Seborrheic Dermatitis / 대한피부과학회지

BACKGROUND: Pityrosporum yeast is a resident microflora of the normal skin and abundant in seborrheic dermatitis. In pathologic conditions, pityrosporum yeast is converted into hyphal form. Previous studies showed that this hyphal form could be found on clinically normal skin too. OBJECTIVES: We compared the incidence of Pityrosporum infection of the external ear canal in normal controls with that in patients with seborrheic dermatitis. METHODS: Seborrheic dermatitis, 258 subjects and normal person, 362 subjects were studied. Ear wax specimens were stained with 20% Parker ink-KOH(P-KOH) solution. The number of pityrosporal hyphae were graded according to hyphal index(1+ to 3+). RESULTS: The incidence of Pityrosporum infection of the external ear canal is 28.7% in patients with seborrheic dermatitis and 24.6% in normal controls, Amounts of pityrosporal hyphae are similar between two groups too. According to age group, incidence of PV of the external ear canal in patients with seborrheic dermatitis is statistically significantly higher than in normal controls. Female with seborrheic dermatitis have more Pityrosporum infection of the external ear canal than normal female controls. Pityrosporum infection of the external ear canal in patients with seborrheic dermatitis is prevalent in summer and spring in contrast to normal controls who have high incidence in spring. Among patients with Pityrosporum infection of the external ear canal, asymtomatic cases amount up to 70%. CONCLUSION: The results of this study showed that the incidence of Pityrosporum infection of the external ear canal in patients with seborrheic dermatitis and normal person is similar, but according to the age, sex and season, there were some differences between two groups.