Presentation
Left ear discharge and hearing loss.
Patient Data
A relatively well-demarcated soft tissue density lesion is seen occupying the inner (medial) portion of the left external auditory canal, which appears inseparable from the tympanic membrane. This lesion appears eroding the scutum superiorly and seems to extend slightly into the lower aspect of the Prussak space. It also appears eroding the anteroinferior wall of EAC. The remaining middle ear cleft, mastoid antrum and mastoid air cells appear clear. A large defect is seen in the cartilaginous portion of the nasal septum.
Incidentally noted:
right-sided high jugular bulb with jugular bulb diverticulum
large nasal septum cartilage perforation.
Case Discussion
Cholesteatoma of the external auditory canal (EAC) is relatively uncommon. It usually presents with otorrhea, otalgia, or hearing loss. The imaging features of EAC cholesteatoma are that of soft tissue mass occupying the canal, associated with bony erosions. It may show extension into the middle ear cleft and mastoid antrum. The main differential of this entity is keratosis obturans which usually causes expansion and bone remodeling of the canal rather than bone erosion.
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