Ear

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• High resolution computed tomography (HRCT) shows loss of pneumatization of mastoid air cells
• In large polyps completely obstructing the external ear, radiographic studies are an invaluable aid in identifying the origin of the polyp
• Key histologic findings: a well circumscribed mass with granulation tissue, mixed inflammation and abundant plasma cells

Contributed by Agnes Ikpoto Udoh, M.D., M.B.A.

• Soft tissue, middle ear, left, biopsy:
  • Inflammatory aural / otic polyp

• Soft tissue, middle ear, left, polypectomy:
  • Otic polyp
  • No malignancy identified

Which of the following statements regarding otic polyps is true?

1. Composed primarily of keratinized squamous epithelium
2. Often associated with a history of cholesteatoma
3. They commonly arise from the tympanic membrane
4. Typically present with sudden sensorineural hearing loss
5. Usually become malignant if untreated

B. Often associated with a history of cholesteatoma. Otic polyps are associated with cholesteatoma in 80% of cases. Answer C is incorrect because otic polyps commonly arise from the mucosa of the middle ear or external auditory canal, rather than the tympanic membrane itself. Answer E is incorrect because otic polyps are typically benign growths composed of granulation tissue, inflammatory cells and sometimes hypertrophic mucosa. Malignant transformation has not been reported in the literature. Answer D is incorrect because otic polyps may lead to conductive hearing loss due to obstruction of the external auditory canal or middle ear space. Sudden sensorineural hearing loss is not a typical presentation of otic polyps. Answer A is incorrect because otic polyps are primarily composed of granulation tissue, which consists of fibroblasts, blood vessels and inflammatory cells, such as lymphocytes and plasma cells. Keratinized squamous epithelium is not a predominant component of otic polyps.

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Reference: Inflammatory aural / otic polyp

A 55 year old woman presents with recurrent episodes of unilateral otorrhea, hearing loss and a sensation of fullness in the affected ear. Examination reveals a pink, fleshy mass protruding into the external auditory canal. Histopathological examination demonstrates hyperplastic squamous epithelium and numerous dilated vessels infiltrated by chronic inflammatory cells. Which of the following is the most likely diagnosis?

1. Cerumen impaction
2. Cholesteatoma
3. Otic polyp
4. Otitis externa
5. Squamous cell carcinoma

C. Otic polyp. It arises from the middle ear but may extend into the external auditory canal if perforated. The mass appears fleshy and is composed of granulation tissue, mixed inflammation and abundant plasma cells. Answer E is incorrect because squamous cell carcinoma typically presents as a nonhealing ulcer often associated with bleeding, pain and hearing loss. Answer A is incorrect because while cerumen impaction can cause symptoms such as hearing loss and fullness in the ear, it typically does not present as a fleshy mass. Additionally, cerumen impaction does not demonstrate the histopathological findings described in the question stem, such as hyperplastic squamous epithelium and dilated vessels infiltrated by chronic inflammatory cells. Answer B is incorrect because cholesteatoma is a benign but locally destructive growth of keratinizing squamous epithelium with keratin debris and inflammation. It is typically not described as a fleshy mass. Answer D is incorrect because otitis externa, also known as swimmer's ear, refers to inflammation of the external auditory canal. While otitis externa can present with otorrhea, hearing loss and a sensation of fullness in the ear, it typically does not manifest as a fleshy mass.

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Reference: Inflammatory aural / otic polyp