External auditory canal osteoma with coexisting canal wall cholesteatoma: a case report and review of literature

Though rare, benign lesions that usually do not necessitate active intervention, osteomas of the external auditory canal, can be troublesome when they start to produce mass effect and severe obstruction to the external auditory canal. Even more insidious is the rarer phenomenon of canal wall cholesteatomas, which have been known to cause significant canal erosion and if left unchecked and spontaneous destruction of the adjacent anatomical structures, including the facial nerve, temporomandibular joint, sigmoid sinus, and skull base. The occurrence of both these exceptionally uncommon findings in the same canal is an unusual finding and may point to an undetermined interplay in pathogenesis.

Here, we describe one such case in a 39-year-old gentleman hailing from South India who presented with complaint of unilateral ear block and decreased hearing and how it was managed.

While osteomas are usually incidental findings in asymptomatic patients, the potential for mass effect and canal obstruction must be kept in mind and patients must be evaluated for development of the more sinister cholesteatoma in the deeper canal.