0:00

This was a patient who had recurrent bouts of

0:03

external otitis as well as, to a lesser extent,

0:07

otitis media.

0:09

On the axial scans through the right

0:11

external auditory canal,

0:12

we see that there is soft tissue sort of plugging

0:15

the beginning of both the cartilaginous as well as

0:19

the bony portion of the external auditory canal.

0:21

We can see that the tympanic membrane is retracted

0:24

inward and the middle ear cavity is reasonably clear.

0:28

You do have some opacification of mastoid air cells,

0:31

but this is predominantly an external auditory

0:34

canal process. At this point,

0:36

I'd probably go into the electronic medical record

0:39

to see exactly what they are

0:41

observing at otoscopy.

0:43

And what was described was a whitish

0:48

soft tissue abnormality that looked inflamed

0:51

in the external auditory canal.

0:53

So given that history,

0:55

I'm sort of out of the vascular

0:57

lesions of hemangioma, venous vascular malformation,

1:00

or for that matter, angiomatous polyp.

1:03

And I start looking at the external

1:06

auditory canal walls.

1:07

I want to see whether or not there is any erosion

1:10

of the wall of the external auditory canal.

1:12

And you can see at the proximal portion of

1:15

the external auditory canal in this case,

1:17

that there is some subtle bony erosion that is a

1:20

little bit more prominent on the posterior

1:22

wall as opposed to the anterior wall.

1:24

And you can see on the sagittal...

1:27

I'm sorry, on the coronal reconstruction,

1:28

that there is some erosion of the superior wall of

1:32

the external auditory canal,

1:34

which may lead to that opacification of mastoid

1:38

air cells. So, given the imaging findings,

1:43

I want to also make sure that this

1:45

patient is not diabetic, because,

1:47

as we discussed previously in the

1:50

infectious portion of the talk,

1:53

malignant otitis externa may be a source of bony

1:56

erosion affecting the external auditory canal,

1:59

which can lead to the soft tissue mass at the

2:02

skull base with osteomyelitis and cellulitis.

2:05

So this patient was not diabetic,

2:07

did not have pseudomonas growing out,

2:09

had not had the ear irrigated,

2:11

so less likely to represent malignantitis externa. malignant otitis

2:15

In point of fact,

2:16

in that history of recurrent infections

2:19

of the external auditory canal,

2:20

it sort of points to the likely diagnosis in

2:23

this case, of an acquired cholesteatoma.

2:26

Far and away, there are more acquired

2:29

cholesteatomas in the middle ear cavity.

2:32

Having one in the external auditory

2:34

canal is unusual but possible.

2:37

And with this whitish lesion that has more of an

2:40

inflammatory nature to it than, for example,

2:43

a mass like an epidermoid congenital cholesteatoma,

2:47

it kind of makes sense.

2:48

And the bony erosion,

2:49

particularly this relatively aggressive looking

2:53

bony erosion in the superior port of the external

2:55

auditory canal, is what sort of tilts the tide more in

3:00

favor of acquired cholesteatoma than anything else.