Questioning the value of stalk drilling after external auditory canal osteoma excision: case series, literature review, and meta-analysis.

OBJECTIVES: To question the value of drilling the site of the stalk ("insertion site" or "stalk" drilling) of a pedunculated external auditory canal osteoma (EACO) in reducing recurrence. DATA SOURCES: A retrospective medical chart review of all patients treated for EACO in one tertiary medical center, a systematic literature review using Medline via "PubMed", "Embase", and "Google scholar" search, and a meta-analysis of the proportion for recurrence of EACO with and without drilling. RESULTS: The local cohort included 19 patients and the EACO origin was the anterior EAC wall in 42% and the superior EAC wall in 26%. The most common presenting symptoms were aural fullness and impacted cerumen (53% each), followed by conductive hearing loss (42%). All patients underwent post-excision canaloplasty, and one sustained EACO recurrence. Six studies suitable for analysis were identified (63 EACOs). Hearing loss, aural fullness, otalgia, and cerumen impaction were the most common clinical presentations. The most common EACO insertion site was the anterior EAC wall (37.5%), followed by the superior EAC and posterior walls (25% each). The inferior EAC wall was least affected (12.5%). There was no significant difference in recurrence between EACOs whose stalk insertions were drilled (proportion 0.09, 95% confidence interval [CI] 0.01-0.22) to the ones whose insertion was not drilled (proportion 0.05, 95% CI 0.00-0.17). The overall recurrence proportion was 0.07 (95% confidence interval 0.02-0.15). CONCLUSION: EACO insertion site drilling does not reduce recurrence and should be avoided in the absence of a definite pedicle projecting to the EAC lumen.

Ossicular osteoma of the malleus-A rare diagnosis of middle ear mass.

Osteoma of the middle ear (MEO) is a rarity. Due to the benign nature and slow growth rate, MEO are often occasionally found by chance. Possible unspecific clinical symptoms may be conductive hearing loss, tinnitus, effusion, and a sense of fullness. If the osteoma is small and not visible in the otoscopic inspection, it may be confused with other conductive hearing loss etiologies, such as otosclerosis. Nevertheless, one should be aware of this rare but important differential diagnosis of middle ear lesions. This article presents an MEO case causing conductive hearing loss and outlines the diagnostic approach with computed tomography.

Middle ear osteoma causing Eustachian tube obstruction: A case report and literature review.

Middle ear osteoma is an extremely rare benign tumor of the middle ear. Due to its very slow growth rate and benign nature, osteoma of the middle ear can be found incidentally without causing any symptoms. The most common clinical signs are conductive hearing loss, the sense of fullness in the ear, tinnitus, and otorrhea. Small-sized osteomas can be misdiagnosed as otosclerosis without showing any signs other than conductive hearing loss. When the mass becomes very large, and symptoms caused by the tumor increase, treatment also becomes difficult. In this paper, we report a case of middle ear osteoma causing conductive hearing loss and effusion due to the effect of pressure on the middle ear ossicles and the Eustachian tube. We also present a review of the pertinent literature.