Case Study 2

The patient is a 65-year old woman who presented with a 3-year history of progressive hearing loss in the right ear. She had no prior history of ear infections or ear surgery. She denied any vertigo or dizziness. She had no family history of hearing loss. She denied any pain, numbness, or weakness. She had no significant medical history, no history of significant sun exposure or head and neck malignancies.

Upon examination, her right ear canal was completely occluded with skin debris not consistent with simple cerumen. Attempts at removing the debris in the office were limited by the patient’s severe discomfort.

The audiogram showed a maximum conductive hearing loss on the right and normal hearing on the left.

Imaging included a CT scan which only showed opacification of the external ear canal with no evidence for bone erosion.

The patient was taken to the operating room at which time the debris was again visualized to be flaky and keratinaceous. A portion of this was traced back to the anterior portion of the cartilaginous ear canal, where it appeared to be adherent to the skin. There were no areas of ulceration or granulation tissue. This lesion was removed en block and sent to frozen pathology, at which time no carcinoma was identified. There was some irregular-appearing tissue along the tympanic membrane and for this reason this was also removed and sent with the specimen. The patient underwent a tympanoplasty without any complications.

Final pathology, however, revealed squamous cell carcinoma. The patient was then taken for a lateral temporal bone resection and external ear canal closure.