0:00

This was a patient who had bilateral

0:03

painful hearing loss,

0:04

as opposed to the previous cases of soft tissue

0:07

masses that are in the external auditory canal,

0:10

in this case,

0:11

you can see that the problem is a bony process which

0:16

is extending into both external auditory canals.

0:21

Here is our cartilaginous portion

0:23

of the external auditory canal.

0:24

Here is the bony portion of the external auditory canal, and

0:27

here we have this bone process which is narrowing

0:32

the bony external auditory canal. And not only that,

0:35

it's a bilateral process. In this case,

0:38

showing the posterior external auditoy canal component,

0:41

as well as the anterior external

0:44

auditory canal component.

0:46

On the coronal images,

0:48

you can see the external auditory canal is here.

0:51

This is the bony portion and

0:53

the cartilaginous portion.

0:55

And along the walls of the bony portion

0:56

of the external auditory canal,

0:58

you have this big block of bone that is effectively

1:03

occluding the external auditory canal.

1:05

This is bilateral exostosis associated

1:10

with the external auditory canal.

1:13

Exostoses of the external auditory canal are a

1:17

phenomenon that is frequently or most commonly

1:20

seen in cold water swimmers.

1:23

So these are people who are either divers or who are

1:30

aficionados of the polar bear

1:33

plunge type of swimming.

1:36

And in the presence of chronic

1:38

stimulus of cold water,

1:40

the external auditory canal may produce these

1:44

exostoses that are bilateral. As I said,

1:47

it is a painful process.

1:49

What's interesting about exostoses is

1:51

that they can be surgically removed.

1:55

But if the swimmer continues that

1:58

habit of cold water swimmer,

2:00

they recur and they again present with bilateral

2:04

painful hearing loss and painful ears,

2:08

and will have to be reoperated.

2:10

So it is something that you can have a recurrence

2:13

thereof. This is to be distinguished from osteomas.

2:17

Generally, with osteomas,

2:18

we're talking about solitary lesions.

2:20

They may be pedunculated,

2:23

and they are usually unilateral.

2:27

This is what these exostoses look like on otoscopy.

2:31

So, if you will,

2:35

what you're seeing here is the tympanic membrane.

2:37

We're actually looking at the

2:40

external auditory canal,

2:41

and this big honker here is the exostosis

2:47

associated with the cold water swimming.

2:51

It does not cross the tympanic membrane, obviously.

2:55

And that's what they see on otoscopy.

3:00

This is another example of the same,

3:03

two different examples.

3:04

One is very similar appearance to the previous

3:07

case. The one below is a little bit more minor case.

3:13

But nonetheless, the finding is the same,

3:16

which is that there is bony thickening bilaterally

3:20

of the external auditory canal. Which...

3:25

this bony thickening of the external auditory canal

3:28

is usually on both sides of the canal.

3:32

It's, on a coronal scan, seen in the superior,

3:36

as well as the inferior walls of the external auditory canal.

3:39

So it's a circumferential process,

3:41

which is why it's more likely to be

3:43

termed exostosis as opposed to

3:47

osteoma.

3:48

So these external auditory canal bony overgrowths

3:52

are caused by repeated cold water swimming.

3:55

Differential diagnosis, the osteoma,

3:57

which is usually a benign, solitary lesion,

4:00

a slow-growing lesion, unilateral lesion,

4:03

and usually asymptomatic.

4:06

This is an example of an osteoma.

4:08

What's curious about this particular example is that

4:11

it doesn't appear to have an attachment

4:14

to the external auditory canal.

4:17

So we're in the coronal plane,

4:20

seeing the cartilaginous portion

4:22

of the external auditory canal,

4:23

the beginning of the bony portion of the external

4:25

auditory canal, and this was the abnormality.

4:27

This was removed and indeed was an osteoma,

4:30

and it had a soft tissue attachment to the superior

4:34

wall of the external auditory canal.

4:38

The differential diagnosis of something

4:40

like this might be an osteochondroma,

4:44

which may have a cartilaginous pedunculated attachment

4:50

to the external auditory canal.