External auditory canal cholesteatoma: classification and management


  • Yahya A. Fageeh Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia
  • Fatma H. Al-Anazy Department of Otolaryngology, Head and Neck Surgery, King Saud University College of Medicine, Riyadh, Saudi Arabia




Ear canal, Clinical findings, Ear discharge, Classification, Hearing loss, Extension


Background: External auditory canal cholesteatoma (EACC) is a disease characterized by the accumulation of keratin in the ear canal and erosion of the bony wall. Etiologically, it may be primary or secondary. It presents with ear discharge and pain. Distinction from similar conditions is crucial for appropriate treatment. This study evaluates the EACC. Its purpose is to suggest categories based on disease extent. This study aimed to evaluate the presentation, diagnosis, and treatment of EACC. The goal was to classify EACC based on disease severity and propose treatment approaches.

Methods: A retrospective review of medical records for patients diagnosed with EACC over ten years. Clinical data were examined for the presentation, clinical findings, etiology, and treatment. We simplified the approach by dividing the disease into three categories: Category 1, confined to the ear canal; Category 2, eroded the canal wall; Category 3, extended to adjacent structures.

Results: 18 patients were included in the study. Ear discharge and otalgia were the most common symptoms. Etiological classification of the disease identified most as secondary EACC. Two cases were assigned to Category 1, six to Category 2, and ten to Category 3.

Conclusions: Common symptoms of EACC are ear discharge, pain, and hearing loss. Our study categorizes the condition into three categories based on severity, extension, and treatment strategies. Most cases were assigned to category 3 and extended into adjacent structures.



Piepergerdes MC, Kramer BM, Behnke EE. Keratosis obturans and external auditory canal cholesteatoma. Laryngoscope. 1980;90(3):383-91.

Naim R, Linthicum F, Shen T, Bran G, Hormann K. Classification of the external auditory canal cholesteatoma. Laryngoscope. 2005;115(3):455-60.

Vrabec JT, Chaljub G. External canal cholesteatoma. Otol Neurotol. 2002;23:241-2.

Dubach P, Mantokoudis G, Caversaccio M. Ear canal cholesteatoma: meta-analysis of clinical characteristics with update on classification, staging and treatment. Curr Opin Otolaryngol Head Neck Surg. 2010; 18(5):369-76.

Naiberg J, Berger G, Hawke M. The pathologic features of keratosis obturans and cholesteatoma of the external auditory canal. Arch Otolaryngol. 1984; 110(10):690-93.

Dubach P, Häusler R. External auditory canal cholesteatoma: reassessment of and amendments to its categorization, pathogenesis, and treatment in 34 patients. Otol Neurotol. 2008;29(7):941-8.

Holt JJ. Ear canal cholesteatoma. Laryngoscope. 1992;102(6):608-13.

Darr EA, Linstrom CJ. Conservative management of advanced external auditory canal cholesteatoma. Otolaryngol Head Neck Surg. 2010;142(2):278-80.

Anthony PF, Anthony WP. Surgical treatment of external auditory canal cholesteatoma. Laryngoscope. 1982;92(1):70-5.

Heilbrun ME, Salzman KL, Glastonbury CM, Harnsberger HR, Kennedy RJ, Shelton C. External auditory canal cholesteatoma: clinical and imaging spectrum. Am J Neuroradiol. 2003;24(4):751-6.

Lin Y-S. Surgical results of external canal cholesteatoma. Acta Otolaryngol. 2009;129:615-23.

Zhang L, Song W. The treatment of facial nerve palsy related to cholesteatoma otitis media. Acta Otolaryngol. 2002;16(4):158-9.

Kim J, Jung GH, Park SY, Lee WS. Facial Nerve Paralysis due to Chronic Otitis Media: Prognosis in Restoration of Facial Function after Surgical Intervention. Yonsei Med J. 2012;53(3):642-8.

Cousin J, Slngh B, Ruffy M, Sperling NM. Facial Nerve Monitoring in Surgery for External Canal Cholesteatoma. Otolaryngol Head Neck Surg. 1996; 115(2):195-6.

Leonetti JP, Matz GJ, Smith PG, Beck DL. Facial nerve monitoring in otologic surgery: clinical indications and intraoperative technique. Ann Otol Rhinol Laryngol. 1990;99(11):911-8.

Bhagat S, Varshney S, Bist SS, Mishra S, Kabdwal N, Kumar R. Case Report: Primary external auditory canal cholesteatoma presenting as cerebellar abscess. Indian J Otol. 2013;19(2):88-91.

Seven H, Coskun BU, Calis AB, Sayin I, Turgut S. Intracranial abscesses associated with chronic suppurative otitis media. Eur Arch Otorhinolaryngol. 2005;262(10):847-51.






Original Research Articles