Central Annals of Otolaryngology and Rhinology Research Article *Corresponding author Jae-Jun Song, Department of Otorhinolaryngology – Head and Neck Surgery, Korea University College of Clinical Features of Benign Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea, Tel: 82-2-2626-3191; Fax: 82-2-868-0475; Tumors of the External Auditory Email: Submitted: 31 March 2017 Accepted: 20 April 2017 Canal According to Pathology Published: 21 April 2017 ISSN: 2379-948X Jeong-Rok Kim, HwibinIm, Sung Won Chae, and Jae-Jun Song* Copyright Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College © 2017 Song et al. of Medicine, South Korea OPEN ACCESS Abstract Keywords Background and Objectives: Benign tumors of the external auditory canal (EAC) • External auditory canal are rare among head and neck tumors. The aim of this study was to analyze the clinical • Benign tumor features of patients who underwent surgery for an EAC mass confirmed as a benign • Surgical excision lesion. • Recurrence • Infection Methods: This retrospective study involved 53 patients with external auditory tumors who received surgical treatment at Korea University, Guro Hospital. Medical records and evaluations over a 10-year period were examined for clinical characteristics and pathologic diagnoses. Results: The most common pathologic diagnoses were nevus (40%), osteoma (13%), and cholesteatoma (13%). Among the five pathologic subgroups based on the origin organ of the tumor, the most prevalent pathologic subgroup was the skin lesion (47%), followed by the epithelial lesion (26%), and the bony lesion (13%). No significant differences were found in recurrence rate, recurrence duration, sex, or affected side between pathologic diagnoses. The overall recurrence rate after excision was 11% and higher in patients with fibro epithelial polyp, intra epidermal pilarepithelioma, and chronic inflammation. Culture of otorrhea identified pathogens in half of patients with recurrence, and the recurrence rate was considerably higher (50%) in cases confirmed to be infected by microorganism. Conclusion: Our results indicated that nevus was the most common pathologic diagnoses. The overall recurrence rate was 11%. Benign external auditory canal lesions that originate from the epithelium and bony canal should be observed closely in the postoperative follow-up period. Furthermore, treatment of infection is thought to be important for preventing recurrence. ABBREVIATIONS as causative factors in EAC tumor; however, conclusive evidence of this is lacking [2]. Symptoms are rare but can include EAC: External Auditory Canal; MSSA: Methicillin-sensitive conductive hearing loss, otalgia, otorrhea, vertigo, and tinnitus. Staphylococcus aureus In previous studies, osteomas were the most commonly found INTRODUCTION pathologic type in EAC [1,3]. Spielmann et al. reported a 10- year case series of 48 surgically resected EAC masses, including Benign tumors of the external auditory canal (EAC) are malignant tumors, benign tumors, infective lesions, and epithelial uncommon among head and neck tumors. The EAC begins at abnormalities. In their study population, bony lesions were the the opening of the cup-shaped portion (concha) of the ear, and extends downward to the tympanic membrane. The adult EAC [1]. Wiatr et al. also retrospectively investigated 26 benign EAC measures 2-3cm in length. The EAC is covered with keratinizing tumormost frequently cases, and encountered osteoma was diagnosis the most of commonEAC benign pathologic tumors diagnosis [3]. However, there are no concrete data supporting this is thicker and contains a subcutaneous layer, hair follicles, conventional idea, especially in Asian countries. Furthermore, sebaceousstratified squamous glands, and epithelium. wax-secreting The skin ceruminous over the lateralglands. portion These the prevalence and clinical aspects of various pathological benign skin appendages are absent in the medial two thirds of EAC, where tumors arising from the EAC have not yet been investigated with the bony wall is closely adherent to the underlying periosteum sufficient sample size. The purpose of this study was to describe [1]. Chronic irritation and inflammation have been considered Cite this article: Kim JR, Im H, Chae SW, Song JJ (2017) Clinical Features of Benign Tumors of the External Auditory Canal According to Pathology. Ann Otolaryngol Rhinol 4(3): 1169. Song et al. (2017) Email: Central the correlation of pathologic diagnoses with clinical features in many cases, however, patients with large EAC tumors complained surgically removed benign tumors of the EAC. MATERIALS AND METHODS of earfulness. In the case of inflammation, otalgia or otorrhea was frequentlyIn 47 cases,observed. tumors were simply excised via an endaural From 2003 to 2014, a retrospective, single-center study approach. In 4 patients, canaloplasty was performed with of EAC lesions was performed using the medical records of excision; 2 of these also underwent tympanoplasty. In one patients who had received surgical treatment for EAC tumors at Department of Otorhinolaryngology-Head and Neck Surgery, postauricular approach was used because of the large size of Korea University Guro Hospital. A total of 53 patients (26 male case, pathologically confirmed as a branchial cleft anomaly, a and 27 female) were included in the present study. All study differences in age, sex, affected side, recurrence rate, and protocols were approved by the Institutional Review Board of recurrencethe mass (3×3cm). duration Statisticalbetween the analysis pathologic revealed diagnoses no significant (P > 0.5). Korea University Guro Hospital (KUGH15144-001). EAC masses Incidence were surgically excised under and general anesthesia in an In this case series, nevus was the most common pathologic operatingwere identified room. with Medical rigid otoendoscopy,records were reviewedand discovered for patients’ lesions age, sex, affected side, pathologic diagnosis, operation records, diagnosis. There were 21 patients diagnosed with nevus (40%), followed by osteoma (7 patients, 13%), EAC cholesteatoma concurrent infection, and recurrence. Patients were classified into (7 patients, 13%), chronic inflammation (6 patients, 11%), one of five categories according to tumor origin (bony, epithelial, epidermal cyst (5 patients, 9%), and others. Among the 21 skin, inflammatory and other benign lesions). The epithelial nevus patients, there were 19 intradermal (90%), 1 compound lesion means the diseases in the most superficial layer of skin, prevalent pathologic subgroup was the skin lesion (25 patients, as the lesions which arise in the dermis and skin appendages (5%), and 1 junctional (sebaceous) pathologic types. The most excludingstratified squamousepithelium. epithelium.Statistical analyses And skin were lesion performed was defined using the Statistical Package of the Social Sciences (SPSS, version 21). 47%), followed by the epithelial lesion (14 patients, 26%), and Results related to patient age are expressed as means (standard theRecurrence bony lesion (7 patients, 13%) (Table 1). eviations, SDs). During the postoperative follow-up period, recurrent lesions RESULTS AND DISCUSSION Patient characteristics were identified under otoendoscopic evaluation in 6 patients (6 From 2003 to 2014, a total of 53 patients were diagnosed with of 53, 11%). The mean follow-up period was 18.4 months. The EAC tumor under otoendoscopy; all patients underwent excision. recurrence rate was 28% (2 of 7) in patients with osteoma, 20% (1 of 5) in those with epidermal cyst, and 17% (1 of 6) in those male and 27 female patients, with an average age of 37.0 ± 19.2 with chronic inflammation. All patients who were diagnosed Baseline characteristics are shown in Table (1). There were 26 epithleialwith fibro polyp epithelial patient, polyp the or tumor intra recurredepidermal twice, pilar necessitating epithelioma aexperienced second revision relapse surgery. and underwent re-excision. In one fibro years. The right side was affected in 26 patients, and the left in 27 (Table 1). Patients with small EAC tumors had no symptom in Table 1: Characteristics of patients with benign EAC tumors. Recurrence Incidence Recurrence Infection Pathologic diagnosis N duration (%) (n [%]) (n) (months) Osteoma 7 13 2(29) 45 0 Chronic inflammation 6 11 1(17) 1 2 Epidermal cyst 5 9 1(20) 1 1 Cholesteatoma 7 13 0 1 Fibroepithelial polyp 1 2 1(100) 1 1 Intraepidermalpilarepithelioma 1 2 1(100) 6 0 14 26 3(21) 3 Skin lesion Nevus 21 40 0 1 Fibrofolliculoma 1 2 0 0 Pilomatricoma 1 2 0 0 Apocrine mixed tumor 1 2 0 0 Apocrine metaplasia of eccrine gland 1 2 0 0 25 47 0 1 Branchial cleft anomaly 1 0 0 Total 53 6(11) 16.5 Abbreviations: EAC: External Auditory Canal 6(11%) Ann Otolaryngol Rhinol 4(3): 1169 (2017) 2/5 Song et al. (2017) Email: Central Among the pathologic subgroups, the recurrence rate was darker pigmentation, whereas more elevated compound nevi have a lighter brown to black color (Figure 1A). Intradermal nevi are elevated lesions without pigmentation (Figure 1B). Lim et al. thehighest skin in lesion the bony group, lesion no grouppatients (29%) experienced followed recurrenceby the epithelial after reported that the intradermal type was the most common among lesion group (21%) and the inflammatory lesion group (17%). In and it was the longest in patients with osteoma (45 months). Noexcision. patients The experienced average duration malignant of recurrence transformation was 16.5 during months, the EAC nevi; the same tendency