Cholesteatoma of the External Auditory Canal: Review of Staging and Surgical Strategy

Introduction: External auditory canal cholesteatomas (EACC) is insidious in nature and rare entity. There are only few case series on EACCs and surgical strategy is not standardized. Objectives: 1) To elucidate etiology of EACC and cardinal features. 2) To suggest a practical staging of EACC. 3) To enumerate surgical management according to stage of EACC. Study Design: Retrospective study in a quaternary referral center of 31 consecutive cases of EACC. Results: Thirty-one patients with EACC were reviewed. Unilateral otorrhea 19 (61.2%), hearing loss 22 (70.9%), and otalgia 8 (25.8%) are cardinal symptoms. Sixteen primary and 15 secondary EACCs were treated. Bone erosion was observed in 20 cases. In the present series, stage III = 12 (38.7%), stage II = 8 (25.8%), stage I = 11 (35.4%) underwent definitive treatment by surgery. Canalplasty with reconstruction was done in 19 cases of stages I and II. Of 12 cases in stage III, 3 cases underwent canalplasty with reconstruction. Subtotal petrosectomy was done in five cases. Intact canal wall mastoidectomy with canalplasty in two cases and radical mastoidectomy in two cases. Fascia, cartilage, muscle, and bone dust were used for reconstruction. Median follow-up period was 6 years and no recurrence of cholesteatoma was observed. Conclusion: EACC is unique entity. Intraoperative and radiological findings assist in correct and practical staging of EACC. Late stage presentations of EACC are common. Definitive surgical treatment in our series avoided recurrence of cholesteatoma.