IP Journal of Otorhinolaryngology and Allied Science

Print ISSN: 2582-4147

Online ISSN: 2582-421X

CODEN : IJOABK

IP Journal of Otorhinolaryngology and Allied Science (JOAS) open access, peer-reviewed quarterly journal publishing since 2018 and is published under the Khyati Education and Research Foundation (KERF), is registered as a non-profit society (under the society registration act, 1860), Government of India with the vision of various accredited vocational courses in healthcare, education, paramedical, yoga, publication, teaching and research activity, with the aim of faster and better dissemination more...


  • Article highlights
  • Article tables
  • Article images

Article statistics

Viewed: 136

PDF Downloaded: 103

Honnegowda, Kumaraswamy, and Gaur: Clinico-Etiological study of benign lesions of pinna and its management


Introduction

Pinna, being the important part of peripheral auditory system, functions to conduct sound waves in the form of vibrations to tympanic membrane.1, 2 Pinna adds to facial aesthetics. The lesions of pinna are not uncommon. Pinna, a delicate, vulnerable structure is more liable for trauma, and its incidence is more commonly reported due to increasing violence, accidents, and high ear piercing. Delay in diagnosis and improper management leads to disfigurement and cosmetic deformity of the pinna.3

Keloid characterized by smooth, pink, rounded scar-like tumour that invariably follows trauma or incision on the skin.1 Keloids are commonly prone for recurrence with need for long time treatment.4 Pseudocyst of auricle is also called as auricular seroma, is a swelling with serous fluid collection between perichondrium and cartilage. It is usually seen in the upper part of auricle. However, the aetiology of seroma is unknown. Based on the swelling and symptoms, seromas of auricle can be differentiated from other lesions of pinna. Because of its high chances of recurrence, successful treatment is challenging.5, 6

Perichondritis, an infection involving cartilage and subcutaneous tissue and it produces swelling which can be severe, and it may lead to focal ear necrosis. The symptoms of perichondritis include pain, erythema, and local warmth. The initial complaint is often a dull ache.7 Herpes Zoster Oticus is defined as acute peripheral facial neuropathy caused by reactivated latent varicella zoster virus (VZV) in geniculate ganglion, characterized by erythematous vesicular rash of the skin of the ear canal, auricle, facial skin, oral mucosa and facial palsy.8 Sebaceous cyst is a benign cyst due to blockage of draining ducts of sebaceous glands leads to cystic dilatation of gland as a result of sebum accumulation. Around the auricle, retention or epidermal cyst is commonly seen, specifically on postauricular sulcus and lobule, because of high sebaceous glands. Some may also arise from hair follicle.1

Neurofibroma are the common lesions of the nervous system. They can arise in all peripheral nerve elements. However, few cases involving neurofibroma have been reported.9, 10 The present study aimed to examine the various types of benign lesions of pinna and management with appropriate intervention.

Materials and Methods

This prospective study was conducted for a period of 2years in Department of ENT of our medical college Hospital, Bengaluru, Karnataka, India. After approval from the Institutional Ethics Committee and Informed consent from study subjects, a total of 140 subjects were examined from ENT out patient department. Males, females, all age groups with various benign lesions of Pinna were included in this study. Patients with congenital lesions, disorders primarily affecting the external auditory canal or the middle ear and malignant conditions were excluded from the study.

A detailed clinical history regarding onset, predisposing factors and associated conditions were collected. Routine blood and urine examination were done for all subjects. In addition to this, culture was done in relevant cases. Depending on the type of lesion patients were managed conservatively or surgically.

Results

A total of 140 subjects were examined in this study from ENT out patient department. In this study, 61 (44%) patients were in age group of 21-30 years, followed by 29(21%) were in the 31-40 years, and 23 (16%) were in the 11-20 years of age group and 76 (54%) were females and 64 (46%) were males as shown in Table 1.

In the present study, most of the patients presented with Keloid, 56(39%), 42(32%) cases were Pseudocyst of auricle, 37(26%) were Perichondritis, Herpes Zoster Oticus and sebaceous cyst were observed in 2 cases each, followed by a case of Neurofibroma as shown in Table 2.

Keloid was more predominant in females than males. Pseudocyst of auricle and Perichondritis were little more in males than female subjects as shown in Table 3. In addition, Keloid was unilateral in 43 (77%) patients and bilateral in 13(23%) cases.

Predisposing factors for keloid such as trauma 8(14%), ear piercing/iatrogenic 37(66%), Burns 2(4%), unknown 9(16%) was observed as illustrated in Table 4. Concerned with Keloid management, 53(95%) were managed with complete excision of the lesion followed by intralesional triamcinolone and 5 cases were treated with intralesional triamcinolone alone.

Pseudocyst auricle was observed in 42 patients, its prevalence was more in males than females. Trauma is the main pre-disposing factor, seen in 29 cases followed by Diabetes mellitus in 3 and unknown in 10 patients as shown in Table 5. In addition, management of Pseudocyst auricle, 42 cases were managed by aspiration and 13 were by window procedure. Out 42 cases, 29(69%) responded to treatment with wide bore aspiration and pressure dressing and rest of the cases were treated with window procedure.

Perichondritis was observed in 37 cases. Trauma was the main factor observed in 20(54%) cases followed by ear piercing/iatrogenic in 10(27%) cases and diabetes mellitus in 5(14%), unknown in 2(5%) cases respectively as shown in table 6. In addition, 29 cases (78%) were managed by incision and drainage and 8(22%) cases were treated conservatively with broad spectrum antibiotics.

3(5%) cases of keloid, 12(29%) cases of pseudocyst of auricle recurred after complete excision and aspiration respectively. 4 cases of perichondritis had thickening and deformity of pinna.

Table 1

Demographic details of patients

Age in years

No. of cases

Percentage

0-10 yrs

1

<1

11-20

23

16

21-30

61

44

31-40

29

21

41-50

19

13

51-60

7

5

Table 2

Distribution of total cases

Diagnosis

No. of cases

Percentage

Keloid

56

39

Pseudocyst of auricle

42

32

Perichondritis

37

26

Herpes Zoster Oticus

02

1

Sebaceous cyst

2

1

Neurofibroma

1

<1

Total

140

100%

Table 3

Sex distribution

Diagnosis

Male

Female

Keloid

13 (23%)

43 (77%)

Pseudocyst of auricle

26 (62%)

16 (38%)

Perichondritis

20 (54%)

17 (46%)

Table 4

Pre-disposing factors for Keloid

Pre-disposing Factors

Number

Percentage

Trauma

8

14%

Ear piercing/iatrogenic

37

66%

Burns

2

4%

Unknown

9

16%

Total

56

100

Table 5

Pre-disposing factors forPseudocyst of auricle

Pre-disposing Factors

Number

Percentage

Trauma

29

69%

Diabetes mellitus

3

7%

Unknown

10

24%

Total

42

100

Table 6

Predisposing factors forperichondritis

Pre-disposing Factors

Number

Percentage

Trauma

20

54%

Ear piercing/iatrogenic

10

27%

Diabetes mellitus

5

14%

Unknown

2

5%

Total

37

100

Discussion

Pinna contributes to the facial contour, any lesion in the pinna drastically alters the appearance. Pinna is a delicate, protruding structure, made of elastic cartilage which makes it more liable for trauma and may lead to hematoma, perichondritis, seroma, etc.3 In the present study, 61(44%) patients were in age group of 21-30 years. In the above age group, people are more concerned about their cosmetic appearance, since pinna is important part of facial aesthesis. In this study, 76(54%) were females and 64(46%) were males. In our study, 86(61%) cases were low income status, and 50(36%) cases were belonging to middle class and only 4(3%) were in upper class. Assessment of socio-economic status was based on modified Kuppuswamy scale. It was known that lesions of pinna are common in low- and middle-class people due to low hygiene conditions.1

The most common finding in this study was Keloid, observed in 56 (39%). The increased prevalence of keloid could be due to increase in the high ear piercing. i.e. ear piercing in cartilaginous part of pinna, considered as fashion and tradition. Compared to males, females were more affected with keloid, this may be due to custom of ear piercing in Indians. Keloids usually depends on the ear-piercing site and also has genetic involvement.1 Trauma 14%, ear piercing/iatrogenic 66% are the most common predisposing factors associated with keloid. Most of the patients with keloid 95% were managed with complete excision of the lesion followed by intralesional triamcinolone.

In a retrospective study conducted by Daniel J Rosen, et al. involving 64 patients with 92 ear keloids, treatment consisted of excision with an intraoperative and two postoperative steroid injections and the success rate was reported to be 80%. 11

In our study, pseudocyst auricle was observed in 42 patients, its prevalence was more in males than females. Trauma is the main pre-disposing factor than others. Most of the Pseudocyst auricle cases managed by aspiration and 13 were by window procedure. Out of 42 cases of pseudocyst auricle, 69% were responded to aspiration and pressure dressing and 30% were treated with window procedure. Recurrence was observed in 3 cases following aspiration. All cases were treated successfully by following window procedure. In a study conducted by Monika Shamrao Malgonde et al, involving 20 patients with auricular seromas reported that aspiration and splint application are the very simple and effective in the management of seromas and it prevents patient distress from fluid recollection and social embarrassment. 5

Similarly, Lim et al, conducted a retrospective study on pseudocyst of auricle involving 9 patients who were treated by simple aspiration of the cyst had prompt re-accumulation of the pseudocyst, reported that none of the patients had recurrence after excision and compression buttoning. 12 Perichondritis was observed in 37 cases. Trauma was the main factor observed in 20(54%) cases followed by ear piercing/iatrogenic in 10 (27%) cases and diabetes mellitus in 5(14%), unknown in 2(5%) cases respectively. The commonest cause of perichondritis is blunt trauma with a subsequent hematoma and secondary infection. However, penetrating trauma can be an inciting cause and may introduce an infection directly. Piercing of the ear, involving punctures of the cartilage have been associated with pinna panniculitis. Similar to this study, Prasad et al, conducted a study on series of 61 cases of perichondritis, and reported that the common factor associated with Perichondritis was trauma. 13

Most of the cases of Perichondritis, 78% were managed by incision and drainage and 22% cases were managed conservatively with antibiotics. In our study, Herpes Zoster Oticus observed in only 2 cases and was managed conservatively. It was believed that this virus infects the facial nerve near the inner ear, causing irritation and swelling of the nerve. This is usually seen in older people (> 60 years). The incidence and severity of the disease is depending on the cellular immunity of the patient. Therefore, elderly patients should be recognized to prevent this virus risk and apt treatment must be initiated at the earliest.14 Sebaceous cysts were observed only in 2 cases and were managed with complete excision.

Conclusion

Our study results conclude that various benign lesions of pinna such as keloid, pseudocyst of auricle, perichondritis, Herpes Zoster Oticus, sebaceous cyst, and neurofibroma of pinna can be managed conservatively or surgically. Trauma is the most important predisposing factor in majority of the lesions. Diabetes Mellitus plays a pivotal role in the prognosis of perichondritis and Herpes Zoster Oticus. Early diagnosis and timely intervention prevent the complications and cosmetic deformity.

Conflicts of Interest

All contributing authors declare no conflicts of interest.

Source of Funding

None.

References

1 

K Srirangaprasad P Kumar S Patil R Mahajan T M Nagaraj K George A clinical study of benign lesions of pinnaJ Evolution Med Dent Sci 2016510414710.14260/jemds/2016/95

2 

PS Chatra Lesions in the external auditory canalIndian J Radiol Imaging2011214274810.4103/0971-3026.90687

3 

KC Prasad S Karthik SC Prasad A comprehensive study on lesions of the pinnaAm J Otolaryngol20052611610.1016/j.amjoto.2004.04.015

4 

V Chaitanya Y Kavitha KP Basavaraju UK Joish A retrospective study of demographic profile of keloid over the pinna in central KarnatakaInt J Otorhinolaryngol Head Neck Surg201843726910.18203/issn.2454-5929.ijohns20181860

5 

M Shamraomalgonde M Kumar Auricular seroma: a new concept inManagementPlast Aesthet Res201411135

6 

H Mahes T Bhat V Vinay David Rao Rosario Cruciate Incision for Treatment of Primary/Recurrent Cases of Seroma/Hematoma of Pinna: A Novel ApproachJ Clin Diagn Res201592MC01MC02

7 

A Lucerna J Espinosa Acute atraumatic pinna (auricular) perichondritisWorld J Emerg Med201892152310.5847/wjem.j.1920-8642.2018.02.013

8 

SK Kannan JE Sherubin S Sajesh KP Gopakumar Ramsay Hunt Syndrome (Herpes Zoster Oticus)J Indian Acad Oral Med Radiol201224170210.5005/jp-journals-10011-1263

9 

S Singh S Tandon A Lahiri S Sharma Neurofibroma of the PinnaInt J Otolaryngol Head Neck Surg20140302667010.4236/ijohns.2014.32014

10 

TS Nee M Ami MK Han Primuharsa Putra Sabir Husin Athar. Postauricular neurofibroma - a rare occurrenceBraz J Otorhinolaryngol20178356001

11 

DJ Rosen MK Patel K Freeman PR Weiss A Primary Protocol for the Management of Ear Keloids: Results of Excision Combined with Intraoperative and Postoperative Steroid InjectionsPlast Reconstr Surg20071205139540010.1097/01.prs.0000279373.25099.2a

12 

C M Lim Y H Goh S S Chao Pseudocyst of the auricleLaryngoscope2009112112033610.1097/00005537-200211000-00022

13 

H K Prasad S Sreedharan HS Prasad MH Meyyappan KS Harsha Perichondritis of the auricle and its managementJ Laryngol Otol20071216530410.1017/s0022215107005877

14 

GP Dhavalshankh AG Dhavalshankh V Mhasvekar A rare case of Herpes zoster oticus in an immunocompetent patientOur Dermatol Online2012343495110.7241/ourd.20124.78



jats-html.xsl

© This is an open access article distributed under the terms of the Creative Commons Attribution License - Attribution 4.0 International (CC BY 4.0). which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Article type

Original Article


Article page

24-27


Authors Details

Tejaswini Honnegowda, Nagarathna Hosalli Kumaraswamy, Sumit Kumar Gaur


Article History

Received : 28-01-2021

Accepted : 06-02-2021

Available online : 20-04-2021


Article Metrics


View Article As

 


Downlaod Files