Wongwan Pithiwat, Prakairungthong Sarun, Atipas Suvajana, Thongyai Kanthong, Limviriyakul Siriporn, Suvarnsit Kanokrat
Department of Otorhinolaryngology, Chonburi Hospital, Chonburi, Thailand.
Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol university, Bangkok, Thailand.
SAGE Open Med Case Rep. 2024 Sep 25;12:2050313X241286689. doi: 10.1177/2050313X241286689. eCollection 2024.
External auditory canal polyps are predominantly inflammatory processes but occasionally indicate more severe pathology. Prolonged conservative management may postpone accurate diagnosis and appropriate therapeutic intervention. This case report presents a 37-year-old woman, previously healthy with a normal ear, who underwent a right myringotomy with the insertion of a pressure-equalizing tube in one hospital after an upper respiratory tract infection. However, due to the pandemic era, she lost follow-up for 2 years and subsequently presented to another hospital with worsening hearing and persistent otorrhea. The attending physician found a large polypoid lesion occupying her right external ear canal. A computerized tomography scan revealed an irregular enhancement mass involving the right ear canal, the middle ear cavity, and mastoid air cells with multiple destruction of the skull base and intracranial involvement in the right middle cranial fossa. The possibility of malignancy was raised, prompting the patient to seek evaluation in a third hospital. A right tympanomastoidectomy was performed, and during a posterior tympanotomy, a pressure-equalizing tube was discovered in her middle ear. The pathological results confirmed the presence of foreign body granuloma. Following surgery, the patient's otorrhea improved.
外耳道息肉主要是炎症性病变,但偶尔也提示更严重的病理情况。长期的保守治疗可能会推迟准确诊断和适当的治疗干预。本病例报告介绍了一名37岁的女性,既往身体健康,耳部正常,在上呼吸道感染后于一家医院接受了右鼓膜切开术并插入了一根通气管。然而,由于疫情时代,她失访了2年,随后因听力恶化和持续性耳漏就诊于另一家医院。主治医生发现一个巨大的息肉样病变占据了她的右外耳道。计算机断层扫描显示一个不规则强化肿块,累及右耳道、中耳腔和乳突气房,伴有颅底多处破坏及右侧中颅窝颅内受累。于是怀疑有恶性肿瘤的可能,促使患者到第三家医院寻求评估。患者接受了右鼓室乳突切除术,在鼓室后壁切开术中,在中耳发现了一根通气管。病理结果证实为异物肉芽肿。手术后,患者的耳漏情况有所改善。