Acquired external auditory canal (EAC) stenosis is relatively rare and results from infection, inflammation, trauma, and tumors. The incidence of acquired EAC stenosis has been estimated at 0.6 cases per 100000 people.
1) Chronic otitis externa is the most common cause of acquired EAC stenosis.
2) Neoplasms such as bony exostosis, benign inflammatory tumors, and malignant lesions can also cause EAC occlusion. Cholesterol granulomas are benign granulomatous lesions caused by tissue reaction to a foreign body. The lesion formation is caused by cholesterol crystals, and occurs secondary to insufficient ventilation, drainage disorders, hemorrhage, and/or chronic inflammation.
3) This process was first described by Manasse
4) in 1894. These lesions have been reported in various regions of the body where cholesterol crystals may form such as the lungs, breasts, peritoneum, mediastinum, liver, spleen, thyroid, kidneys, lymph nodes, testis, facial skeleton, skull, and the temporal bones.
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8) Within the temporal bones, cholesterol granuloma is known to occur most commonly in the petrous apex.
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10) With few cases of cholesterol granuloma presenting as a mass in the EAC having been reported, occlusion of the entire EAC by a cholesterol granuloma in a pediatric patient is quite rare.
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11) A pre-operative diagnosis of the EAC-occluding mass is necessary to devise appropriate treatment, reduce operative complications, reduce post-operative morbidity, and effectively restore hearing. Correct diagnosis of EAC stenosis is challenging in young children owing to the low incidence of EAC masses in the pediatric population. Here, we report a large cholesterol granuloma occupying the entire EAC and resulting in its total occlusion in a 12-year-old girl. The granuloma was diagnosed via medical imaging and surgically excised.