DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20202229

An external auditory canal swelling: a pseudo meningocele

Vijay G. Bidkar, Vaibhav Chavan

Abstract


The author presents a case of an external auditory canal swelling. A pseudo meningocele, delayed complication of mastoidectomy. Differential diagnosis of swelling in the ear canal includes various conditions. The study aims to discuss management and review the literature of this uncommon condition. A 34-year lady presented with right ear canal swelling, reduced hearing and occasional watery ear discharge. Patient had undergone ear surgery 14 years back. Radiological studies including computed tomography and magnetic resonance imaging were suggestive of defect in the tegmen and posterior canal wall and presence of swelling containing cerebrospinal fluid (CSF) in mastoid cavity. Post aural trans mastoid approach was planned and multi layered closure of the defect was done under adequate antibiotic coverage. Pseudo meningocele may manifest as delayed complication of mastoid surgery and risk of meningitis is higher as CSF containment to its space is failed. Trans mastoid resection of swelling and reconstruction of the skull base is preferred modality of treatment considering size of the defect.


Keywords


Acquired meningocele, Computed tomography, Mastoid bone, Cerebrospinal fluid

Full Text:

PDF

References


Wormald PJ, Browning GG. Otoscopy a structured approach. London: Hodder Arnold; 1996.

Fenton JE, Turner J, Fagan PA. A histopathologic review of temporal bone exostoses and osteomata. Laryngoscope. 1996;106(5 Pt 1):624-8.

Alyono JC, Corrales CE, Gurgel RK, Blevins N, Jackler RK. Facial nerve schwannomas presenting as occluding external auditory canal masses: a therapeutic dilemma. Otol Neurotol. 2014;35(7):1284-9.

Mehendale NH, Samy RN, Roland PS. Management of pseudomeningocele following neurotologic procedures. Otolaryngol Head Neck Surg. 2004;131(3):253-62.

Brown NE1, Grundfast KM, Jabre A, Megerian CA, O'Malley BW Jr, Rosenberg SI. Diagnosis and management of spontaneous cerebrospinal fluid-middle ear effusion and otorrhea. Laryngoscope. 2004;114(5):800-5

Acuin J. Chronic Suppurative Otitis Media: Burden of Illness and Management Options. Geneva, Switzerland: World Health Organization; 2004.

Nelson RF, Gantz BJ, Hansen MR. The rising incidence of spontaneous cerebrospinal fluid leaks in the United States and the association with obesity and obstructive sleep apnea. Otol Neurotol. 2015;36:476-80.

Nguyen LT, Baik FM, Doherty JK, Harris JP, Nguyen QT. Exostoses and osteomas of the internal auditory canal. Laryngoscope. 2010;120(4):215.

Hilton M. Scott- Brown’s Otorhinolaryngology Head & Neck Surgery. 8th Ed. Chapter 74, Vol 2: New York: Taylor & Francis Group, LLC; 2019: 931.

Alyono JC, Corrales CE, Gurgel RK, Blevins N, Jackler RK. Facial nerve schwannomas presenting as occluding external auditory canal masses: a therapeutic dilemma. Otol Neurotol. 2014;35(7):1284-9.

Smith MCF, Huins C, Bhutta M. Surgical treatment of chronic ear disease in remote or resource-constrained environments. J Laryngol Otol. 2018;19:1-10.

Scurry WC Jr, Ort SA, Peterson WM, Sheehan JM, Isaacson JE. Idiopathic temporal bone encephaloceles in the obese patient. Otolaryngol Head Neck Surg. 2007;136(6):961-5.

Andersen SAW, Guldager M, Mikkelsen PT, Sørensen MS. The effect of structured self-assessment in virtual reality simulation training of mastoidectomy. Eur Arch Otorhinolaryngol. 2019;276(12):3345-52.

Pelosi S, Bederson JB, Smouha EE. Cerebrospinal fluid leaks of temporal bone origin: selection of surgical approach. Skull Base. 2010;20(4):253-9.

Schick B, Dlugaiczyk J. Surgery of the ear and the lateral skull base: pitfalls and complications. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2013;12.

Savva A, Taylor MJ, Beatty CW. Management of cerebrospinal fluid leaks involving the temporal bone: report on 92 patients. Laryngoscope. 2003;113(1):50-6.