Ear canal cholesteatoma: meta-analysis of clinical characteristics with update on classification, staging and treatment

Current Opinion in Otolaryngology & Head and Neck Surgery (Aug 2010)

Dubach P, Mantokoudis G, Caversaccio M; 

PURPOSE OF REVIEW: We present an update on clinical evaluation, staging, classification and treatment of canal cholesteatoma, including a meta-analysis of clinical data of the last 30 years. 

RECENT FINDINGS: Ear canal cholesteatoma is frequently associated secondarily to other canal pathologies. The cause for the rare idiopathic form of the disease remains enigmatic. Epidemiologic and experimental studies of its pathogenesis have increased; however, the main explanatory theory of a deficient migratory capacity of the canal epithelium affected has been falsified only recently. Therefore, the debate on the pathogenesis has gained additional impetus and more data is needed. 

SUMMARY: Canal cholesteatoma is a rarity in otologic pathology, often leading to misdiagnosis as external otitis or otomycosis by physicians unfamiliar with the disease. It presents typically with otorrhea, focal erosion and keratin accumulation in the osseous ear canal and has to be distinguished from keratosis obturans, which leads to otalgia and bilateral conductive hearing loss by ceruminal plugs, with circumferential distention of the ear canal. Treatment by canaloplasty is curative and highly successful. Alternative conservative treatment is feasible, however, requiring long-term follow up, with often painful cleaning of the lesion.

Fungal infection of the ear: A common problem in the north eastern part of Haryana.

Int J Pediatr Otorhinolaryngol. 2010 Mar 25. [Epub ahead of print]
Aneja KR, Sharma C, Joshi R.

Department of Microbiology, Kurukshetra University, Kurukshetra 136 119, Haryana, India.

OBJECTIVE: The aim of this study was to determine the prevalence of fungal agents, sex distribution and predisposing factors involved in otomycosis. METHODS: Samples from the 118 clinically suspected patients of otomycosis were collected between January 2008 and February 2009, with an age group of 6 and 75 years. Mycological examination of all the samples was done to isolate the fungal agents involved in otomycosis.

RESULTS: Mycological examination has revealed the confirmation of fungal otomycosis in 78% of the suspected patients. Pruritus has been found as the most common symptom. The major predisposing factors responsible for the otomycosis have been found as the wearing of traditional customary clothes followed by itching on other body parts and swimming. It has been found to be more prevalent in females than males in the age group of 31-40 years, higher incidence occurring in the rainy season. The fungi involved in otomycosis belonged to Aspergillus niger, A. flavus, A. fumigatus, A. luchuensis, A. terreus, Candida albicans and Penicillium sp. Of these, A. niger followed by A. flavus were the dominant fungi. Aspergillus luchuensis as the cause of otomycosis has been reported for the first time.

CONCLUSION: Finally we can say higher incidence of otomycosis may be due to high degree of humidity, warm and dusty environment. So, keeping in view the high prevalence of otomycosis in India, critical diagnosis of the causative agent by employing aseptic and proper culture techniques and susceptibility testing for proper treatment of this disease is the need of the hour. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.