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A 36-year-old patient presented with an 18-month history of intermittent right parotid swelling accompanied by otorrhoea. The symptoms started subsequent to a palm leaf injury to the right ear. At right parotidectomy, a fistula connecting the right external auditory canal and the right parotid was demonstrated. A small fibrotic mass probably due to a remnant of the palm leaf was found intraoperatively. The symptoms resolved completely after the mass was excised by superficial parotidectomy, and the fistula closed spontaneously.

Herein, we describe a case of an 81-year-old woman who was found hanged in the kneeling position, at the height of about 1.3 m, with anterior position of the knot. There were two downward directed stripes of dried blood coming out of the left nostril and left ear, while the right ear was filled with a small pool of blood. Since the hanging occurred in the kneeling position with the head "on top," it is likely that the anterior position of the knot, with only (partial) weight of the head pulling the noose, resulted in complete obstruction of the venous flow, but only partial obstruction of the arterial flow, probably including both carotid and vertebral arteries. The venous pressure rise was not caused by the position of the head, meaning that it required a "pump," that is, preserved circulation and heart function. The first finding that speaks in favor of this mechanism is the small pool of blood in the right external auditory canal, since its position is completely antigravitational. The second one, even more convincing, is the finding of the so-called trout phenomenon, that is, petechial bleeding on upper and lower eyelids and on the skin between the eyebrows, because this phenomenon requires impaired or obstructed venous return in the presence of continued arterial input. We can conclude that in this case of atypical, incomplete, suicidal hanging, otorrhagia was a vital reaction.

Adenoid cystic carcinoma of the external auditory canal is very rare tumour. Its course is mainly indolent, and is characterised by intracranial extension, high rates of loco-regional relapse, and distant metastasis, which culminates in a slow detrimental disease course, eventually leading to death. The main therapeutic modalities are local therapies such as surgery and/or radiotherapy. Systemic treatment has never achieved good clinical outcomes in this setting. Here, we describe the case report of a 50-year-old female, diagnosed with an adenoid cystic carcinoma of the right external auditory canal in 2003. The patient developed multiples recurrences, including an extensive intracerebral progression associated with radio necrosis, for which systemic therapy with bevacizumab and epirubicin was initiated. This achieved an intracerebral partial response with clinical benefit, allowing the rapid tapering of corticosteroid treatment. This case report highlights epirubicin in combination with bevacizumab as a therapeutic option for heavily treated patients with adenoid cystic carcinoma and intracranial involvement.

Arthropods may become lodged inside the ear and cause considerable emotional and physical trauma. Cases of centipedes being lodged in the external auditory canal have rarely been reported. In this article, we present the case of woman who had a centipede lodged inside her right external auditory canal. Removal using a topical local anesthetic can lead to vigorous activity of the centipede, which can cause harm to the patient and clinicians. Therefore, we developed and successfully applied a practicable method that involved using a modified plastic bottle for safe centipede removal. In conclusion, centipedes can express distinct and threatening behavior, and clinicians should pay attention to the activity of the lodged centipede and possibly use the proposed method to safely remove it.

Objective: To discuss a rare case of temporal bone capillary hemangioma, and its diagnosis and management. Methods: Design: Case Report Setting: Tertiary Government Hospital Patient: One Results: A 44-year old woman with a history of on-and-off right ear discharge, tinnitus and decreased hearing, and a pinkish, smooth-surfaced, non-friable, non-pulsating mass occluding the right external auditory canal, was initially treated for chronic suppurative otitis media with aural polyp. A punch biopsy due to persistence of disease despite medical treatment revealed capillary hemangioma. She underwent canal wall down mastoidectomy with obliteration to completely resect the tumor. Conclusion: Capillary hemangiomas of the temporal bone are benign lesions that may lead to complications such as bone erosion, hearing loss, recurrent infection and bleeding if left untreated. Surgery remains the ideal treatment, and recurrence is rare and the prognosis is good if resection is complete. Keywords: Hemangioma, capillary hemangioma, temporal bone, middle ear

Objective To investigate the effects of conductive hearing loss (CHL) on vestibular evoked myogenic potentials (VEMPs) using a simulated CHL model, and to provide the basis for future studies. Methods Twenty-one healthy subjects were recruited in this study. We measured ocular VEMPs (oVEMPs) and cervical VEMPs (cVEMPs) in these subjects by air-conduction sound (ACS) stimulation. CHL was simulated later by blocking the right external auditory canal with a soundproof earplug to evaluate its impacts on VEMPs. Subjects' responses before simulated CHL served as the control, and were compared to their responses following simulated CHL. Results oVEMPs following simulated CHL showed decreased response rate, elevated thresholds, attenuated amplitudes and prolonged N1 latencies compared with those before simulated CHL, and the differences were statistically significant. Similarly, cVEMPs following simulated CHL also showed decreased response rate, elevated thresholds and attenuated amplitudes, with prolonged P1 latencies compared with those before simulated CHL, although only differences in response rate, threshold and amplitude were significant. Conclusions Conductive hearing loss affects the response rate and other response parameters in oVEMPs and cVEMPs.

Introduction Only two reports in English literature have described cement foreign bodies in the external auditory canal. Case summary We present the case of a 37 year-old man with cement foreign body in the right external auditory canal. Removal of the foreign body was difficult because of severe adhesion to the external auditory canal and tympanic membrane. We therefore used acidic Burow's solution to dissolve the alkaline cement deposition. Application of Burow's solution immediately caused the deposition to take on a paste-like consistency that was easily removed. Discussion Burow's solution seems useful for removing cement foreign bodies in the external auditory canal.

Background Hemangiopericytomas (HPCs) are soft tissue tumors with histological variability and unpredictable clinical and biological behavior. HPCs in the head and neck are uncommon, the growth pattern is nonspecific; thus, diagnosis is often made by exclusion. Methods A 43-year-old man complained of a short history of right ear pain associated with a growing mass in the right external auditory canal. Subsequent hearing loss in the right ear brought the patient to undergo a CT scan and an MRI. The relevant literature was also reviewed. Results The imaging revealed a neoplasm arising from the floor of the right external auditory canal. The neoplasm was removed with the diagnosis of HPC. Conclusion The literature reports few cases of HPC of the external auditory canal. Their rarity in this area leads to difficulties in diagnosis. Morphology is not predictive of their behavior, so close follow-up is mandatory for their correct management. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Objectives: Compound nevus is a nevocytic nevus comprised of fully formed nests of nevus cells in epidermis and dermis and has malignant potential. The occurrence of this entity in the external auditory canal (EAC) is rare. The authors report a case of papillomatous nevus that almost completely obstructed an EAC and caused conductive hearing loss. Methods: A case report. Results: A 54-year-old female patient visited our hospital due to a progressive reduction of right-side hearing ability over the previous two years. During physical examination, a skin-colored papillomatous mass was observed to fully fill the right external auditory canal. Tissue examination revealed it a compound nevus. The mass and surrounding dermal tissue were surgically excised. At one month after surgery, the external auditory canal had healed completely and auditory testing results were normal. Conclusion: The ear canal was closed by papillomatous compound nevus in the external auditory canal, and such obstruction or narrowing causes conductive hearing loss. Transmeatal approach and secondary wound closure is used treated by wide excision.

Retiform hemangioendothelioma is a rare intermediate or borderline neoplasm of the blood vessels that mostly occurs in extremities. Here we report a unique case of retiform hemangioendothelioma presented in the external auditory canal. 58-year-old male patient presented with the complaint of right ear swelling for 4 years. On examination, a spherical swelling in the right ear was found occluding the view of external auditory canal. The tumor was removed surgically. Intraoperatively, the mass was found attached to the outer part of the right external auditory canal near the root of helix. Histopathology of the resected tumor showed typical features of retiform hemangioendothelioma. In addition, immunohistochemical analysis revealed that tumor was positive for endothelial cell marker CD34 and occasionally positive for cell proliferative marker Ki-67.

Report a case of malignant transformation of benign ear canal papillomatosis to malignant squamous cell carcinoma (SCC) of the temporal bone.A 73-year-old with papillomata involving the posterior and inferior walls of the right external auditory canal (EAC), which subsequently transformed into SCC.Radical mastoidectomy and excision of the tumor and then radical radiotherapy.Loco-regional disease control. Recovery of facial nerve function.Approximately 20 months post-treatment, the patient remains disease free. No recovery of facial nerve function.Malignant transformation of a benign EAC papilloma to SCC of the temporal bone has not been reported previously. The association of human papillomavirus with temporal bone SCC has been reported in small number of studies with human papillomavirus subtypes 16 and 18 isolated in a high proportion of cases. With the increased availability in genotyping, the question over whether there should be further genetic analysis of benign lesions to assess their susceptibility to malignant transformation has merit.

Cutaneous neuroendocrine carcinoma (cNEC) is rarely seen in the external ear. In this paper, we newly describe a patient with cNEC in his right external auditory canal, followed by a further discussion on the clinical features, diagnosis, and treatments of cNEC of the external ear. A review of the literature showed that cNEC of the external auditory canal generally presents as asymptomatic and that pathology yields the most confirmative diagnosis. A wide resection with adjuvant radiotherapy and chemotherapy is recommended. The overall prognosis of this condition is poor.

Fanconi's anemia, type A presenting as VACTERL association with atresia right external auditory canal

Seborrheic keratosis is one of the most common benign neoplasms seen at the trunk, extremities, head and neck of older individuals which rarely occurs in the auditory canal. Even rarer is the occurrence of an inverted or hyperkeratotic variant in this localization. We present the clinical picture of a 74-year-old man with a recurrent hyperkeratotic, partially inverted seborrheic keratosis of the right external auditory canal. This disease is sometimes difficult to diagnose, particulary to mark down malignant lesions. An uncritical diagnosis must be avoided, since these lesions and especially the irritated subtype might be falsely assessed as basal cell carcinomas which they may resemble histologically.

A 24-year-old female was admitted to our hospital complaining of right otalgia persisting for a few days after a trip to Nepal. Otoscopic examination showed a tick in the right external auditory canal. The tick was removed with forceps. The tick was identified as a nymphal Dermacentor sp. There was no sign of serious complication such as tick paralysis or facial palsy.

Tumors of ceruminous glands origin are rare in humans. We report a case of ceruminous adenocarcinoma presented with a swelling of the right external auditory canal. The patient underwent excision of the auditory canal. The patient has not shown any sign of recurrence or distant metastasis for 1 year since surgery. The clinical aspect of this tumor is discussed, followed by a brief literature review.

Sebaceous epithelioma is a rare skin tumor with sebaceous differentiation. Histopathologically, it is composed of undifferentiated basaloid cells, differentiated sebaceous cells and transitional cells. Our patient was an 80 year-old man with an asymptomatic tumor in the right external auditory canal. The tumor was 1.2×0.8cm and had a stem at the lower wall of the external auditory meatus and could be completely resected. During a one-year follow-up period, there was no recurrence of the tumor.

This case report demonstrates the otologic complications of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis (SJS/TEN). A five year-old male was admitted to the burn unit with the diagnosis of SJS/TEN believed secondary to acetaminophen use. After resolution of the acute phase, the patient was left with a severe auricular deformity with scarring and complete occlusion of the right external auditory canal (EAC). The patient underwent meatoplasty, canaloplasty, and tympanoplasty with subsequent placement of a molded stent in order to maintain patency of his EAC. Four years later, the patient has a patent right EAC with adequate hearing.

We present a case where a patient sustained a tympanic plate fracture of the right side while chewing a sandwich. Intense pain with temporomandibular joint (TMJ) symptoms such as restrained painful mouth opening and functional pain in full occlusion followed the incident and the fracture was diagnosed after ocular and CT-examination of the right external auditory canal. Non-ruptured soft tissue could be seen protruding into the external auditory canal and the size of the mass changed during movement of the TMJ. Treatment was not needed to resolve the situation and at 3-year follow-up the patient has no clinical symptoms.

A tumor was removed from the right external auditory canal of a 69-year old female patient. The histopathological and immunhistochemical evaluation revealed a pleomorphic adenoma (mixed tumor). The differential diagnosis of the tumors derived from the ceruminal glands, their clinical and prognostic implications as well as the histogenesis of pleomorphic adenomas in this localization are discussed.

We report the case of a 6-year-old girl with a small, round-shaped foreign body, composed of polyvinyl alcohol, in her right external auditory canal. This foreign body was originally a component of toy beads with which children are able to make variously shaped objects by sticking them together using water. Polyvinyl alcohol is a water-soluble polymer and is employed as an adhesive agent. In our case, it was not easy to remove it because it had fully adhered to her external auditory canal.It is important to note that this kind of foreign body should not be attempted to be removed by water irrigation, as this would cause it to dissolve and stick to the tissue.

A 74-y-old male receiving haemodialysis presented with right-sided otalgia, otorrhoea and diffuse swelling on the right external auditory canal. Following an initial successful treatment with prolonged intravenous antibiotics, the patient relapsed with a secondary infection in the same site due to Candida glabrata. We report an unusual case of malignant otitis externa caused by the fungus C. glabrata.

Afive-year-old boy was referred to our department with intermittent serous otorrhea due to a recurrent mass in his right external auditory canal (EAC). When the patient was four years of age, this lesion had been removed at another hospital. Histologically, the lesion was consistent with a ceruminoma. No other symptoms or signs were reported. A 0.6-cm pink-reddish, condyloma-like mass that bled easily was localized in the superior wall of the EAC at the level of the bone-cartilage junction (Fig 1). The tympanic membrane was normal. Computed tomography revealed no deep extension of the lesion. The lesion was removed completely via a transmeatal approach, and no histological involvement of the cartilaginous or bony EAC was detected. Histopathology revealed a well-differentiated, localized neoplasm with papillary proliferation of glands similar to normal ceruminous glands. This pattern was diagnosed as adenoma of the ceruminous glands (ceruminoma). At the one-year follow-up, the patient was tumor free. The institutional review board of Sapienza University approved this article.

Amyloidosis of the external auditory canal is extremely rare. Only 12 cases, including the present case, have been reported, and this is the second reported case attributed to dialysis. This case involved a 56-year-old man who had been on dialysis for 12 years. A tumor was visible in the right external auditory canal and caused pain. The tumor was resected at another hospital, but subsequently recurred with rapid increase in size due to infection. We therefore performed further resection at our hospital. We report our experiences herein, together with a discussion of the literature.

Two patients were treated surgically for adenoid cystic carcinoma of the external auditory canal. A 24-year-old woman complained of pain and preauricular swelling. The diagnosis was confirmed by biopsy of the posterior wall of the right external auditory canal. Histopathological study revealed typical tubular type of adenoid cystic carcinoma. She was treated primarily with en bloc resection of the external auditory canal, radical mastoidectomy, parotid gland extirpation and regional lymphnode resection for the purpose of complete surgical removal of the tumor. Thereafter, irradiation was done. The second patient was an 80-year-old man, who complained of earache. The diagnosis was confirmed by biopsy of the anterior wall of the left external auditory canal. Histopathological study revealed cribriform type of adenoid cystic carcinoma. He was treated only with en bloc resection of the external auditory canal because of his age and because his tumor was limited to the cartilagenous part of the external auditoryanal.

We report on a 45-year-old male patient with the signs of exophytic, obstructive and painless tumour of the right external auditory canal developed within a period of about 3 months. The tumour was completely removed in local anaesthesia and histologically found to be a leiomyosarcoma. The only possible origin of this lesion might be the smooth muscle cells of the local blood vessels or the mm. arrectores pilorum.

A rare case of a 51-year-old female with a pleomorphic adenoma, measuring 0.9 x 0.7 x 0.6 (cm3), originating from the right external auditory canal (EAC), was reported. The authors discussed the 7 reported cases of EAC pleomorphic adenoma in Japan, comparing them with pleomorphic adenomas occurring in the nasal cavity and the parotid gland. It is currently too early to conclude that pleomorphic adenoma in the EAC does not tend to recur or shows a marked tendency toward canceration. The best possible treatment for EAC pleomorphic adenoma at present seems to be, as in cases of tumors in other sites, surgical resection together with removal of a sufficient range of surrounding normal tissue, followed by careful long-term postoperative observation of the clinical course.

We report a 55-years-old male with cerminous adenoma originating in the osseous part of the right external auditory canal, and describe the clinical features and surgical treatment.

A patient developed atresia of both external auditory canals following a traffic accident. Bilateral atresia of the auditory canals is very rare and has never been reported in Japan. The occluded portions of the canals were resected through a postauricular approach. In the right external auditory canal, a cholesteatoma-like accumulation was found behind the obstruction. The operation restored the hearing in both ears tonearly normal. Twenty-two cases of post-traumatic atresia of an external auditory canalreported to date in Japan are reviewed, and the pathology, pathogenesis and treatment are discussed.

Objective: To report an extremely rare variant of first branchial cleft anomaly. Case report: A-13-year old boy presented with the chief complaint of persistent right aural discharge since infancy. On examination, a 1 mm fistulous opening was present in the floor of cartilaginous portion of external auditory canal. And scanty watery discharge came out through this opening when the patient asked to swallow. Sinogram through discharging meatal opening showed a thick irregular tract about 5 cm length traversing the soft tissue of neck extending from the floor of right external auditory canal to the lateral pharyngeal wall and spillage of contrast into the oral cavity. Conclusion: This was an extremely rare variant of first branchial cleft fistula. Due to the rarity of this disease, clinical misdiagnoses and inappropriate management may lead to recurrence and complications. For better prognosis, appropriate diagnosis and surgical planning are very important. Key words: Objective: To report an extremely rare variant of first branchial cleft anomaly. Case report: A-13-year old boy presented with the chief complaint of persistent right aural discharge since infancy. On examination, a 1 mm fistulous opening was present in the floor of cartilaginous portion of external auditory canal. And scanty watery discharge came out through this opening when the patient asked to swallow. Sinogram through discharging meatal opening showed a thick irregular tract about 5 cm length traversing the soft tissue of neck extending from the floor of right external auditory canal to the lateral pharyngeal wall and spillage of contrast into the oral cavity. Conclusion: This was an extremely rare variant of first branchial cleft fistula. Due to the rarity of this disease, clinical misdiagnoses and inappropriate management may lead to recurrence and complications. For better prognosis, appropriate diagnosis and surgical planning are very important. Key words: First branchial anomaly; branchial cleft fistula; branchial cyst; fistulography. DOI: 10.3329/bjo.v17i1.7633 Bangladesh J Otorhinolaryngol 2011; 17(1): 72-75 . DOI: 10.3329/bjo.v17i1.7633 Bangladesh J Otorhinolaryngol 2011; 17(1): 72-75

• We report a rare case of bilateral carcinoma of the ears in a 41-year-old man. The second tumor developed from the left mastoidectomized middle ear cavity eight years after the complete healing of the first tumor, which probably originated in the glands of the right external auditory canal. ( Arch Otolaryngol 102:112-114, 1976)

A 55-year-old male with acute myeloid leukemia, which had been well controlled for 2 years, developed a sudden onset of facial palsy. Otologic examinations proved the right mastoid bone to be infiltrated by leukemic cells, which formed a nonchloroma to occlude the right external auditory canal. The precise site for the right facial paralysis by tumor formation was found in the intrastapedial region of peripheral portion of the right facial nerve. Regarding the tumor formation in myeloid leukemia, its frequency (particularly among Japanese subjects), complications (particularly in otologic field), possible pathogeneses, and treatments were discussed.

We report a 12-year-old lightning victim with right subcortical parenchymal and right lentiform nucleus haemorrhages documented by computed tomography (CT) and magnetic resonance imaging (MRI). A linear entry burn with an area of singed hair on the scalp was obvious. Neurological examination did not show any lateralized deficit. Cranial nerves were intact. A laceration on the right external auditory canal, elevated cardiac enzymes and electrocardiographic changes were also recorded. The boy was discharged on the sixth day. Prolonged loss of consciousness in lightning victims may suggest intracranial injury. Although brain CT can demonstrate intracranial haemorrhages, MRI is mandatory to show subcortical parenchymal haemorrhage in lightning victims.

A 33-year-old man had a one-year history of decreased hearing and intermittent foul-smelling otorrhea of the right ear. On examination, the right external auditory canal was occluded by a soft, pink, smooth, rounded mass. A biopsy specimen was consistent with a diagnosis of chronic otitis externa. The tomograms of the petrous temporal bones revealed the right middle ear space to be less pneumatized than the left. The right external auditory canal mass was removed in piecemeal fashion under general anesthesia (Fig 1). The medical history was important in that ten years before the patient was treated for a mass in his nasopharynx (Fig 2). What is your diagnosis?

Case 1. —Mrs. K., a pregnant woman, aged 33, mother of two children, came to my office, July 28, 1926, complaining of pain, unbearable itching and buzzing in the right ear. The symptoms began gradually two weeks prior to her visit, increasing daily in severity. For the past few days she also noticed a sensation of fulness and could not hear so well in the right ear. Examination of the right external auditory canal revealed a dirty gray, soft mass covering the floor and the anterior wall of the canal, and extending onto the drum membrane. Believing this mass to be a mixture of exfoliated epithelium and cerumen, I proceeded to syringe the canal. This brought forth a smooth, soft, slippery mass and revealed an inflamed canal and drum membrane. She was then advised to instil a mixture of hydrogen peroxide and water into the canal several times daily, and sent