A 48 year-old man with severe persistent otalgia

 

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Doctor's Information

Name : Maryam
Family :Noori
Affiliation : ----------------
Academic Degree: ----------------
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : ----------------

 

Patient's Information

Gender : Male
Age : 48

 

Case Section

Head & Neck Imaging

 

Clinical Summary

A 48 year-old man with severe persistent otalgia.

 

 

Imaging Procedures and Findings

A 48 year-old diabetic man with severe persistent otalgia further evaluated. Performed CT scan images using contrast revealed enhancing soft tissue mass with the rim enhancing area in the region of external auditory canal & parotid space. It is associated with bony erosion and middle ear extension.

 

Discussion

The best diagnostic clue is swollen EAC soft tissues with bony erosion & adjacent deep space cellulitis or abscesses. EAC cholesteatoma often secondarily inflamed or infected. It is Unilateral soft tissue EAC mass with underlying bony destruction & intramural bony "flakes" is seen in 50%. External auditory canal squamous cell carcinoma can have a similar appearance to necrotizing external otitis but they are elderly patients with known EAC skin squamous cell carcinoma. Also skull base osteomyelitis & necrotizing external otitis may mimic malignancy & sometimes requiring biopsy for pathologic differentiation. Post-inflammatory medial canal fibrosis characterized by formation of fibrous tissue in medial aspect of bony EAC associated with obstructive fibrous tissue within medial EAC without bony erosion. Chronic otitis externa or surgical procedure is causal.

 

Final Diagnosis

Malignant External Otitis.

 

References

Diagnostic Imaging Head & Neck, Harnsberger, et al. Fundamental of diagnostic radiology, William E. Brant, Clyde A. Helms.

 

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