Neglected keratosis obturans causing facial nerve palsy

External Auditory Canal Cholesteatoma Involving the Vertical Segment of the Facial Nerve: A Rare Case Report

External auditory canal cholesteatomas (EACC), are rare, more so when they affect the facial nerve in its vertical mastoid segment. EACC are known to possess bone eroding properties, causing a variety of complications, similar to the better-known attic cholesteatomas. We describe here the novel surgical management of a case of EACC, affecting only the vertical segment of the facial nerve, causing seventh nerve palsy at the time of presentation. A 46 year old male, complaining of right-sided otalgia and otorrhea, presented with grade IV facial palsy and associated mild conductive hearing loss. Clinical examination and radiological investigations suggested the diagnosis of an external auditory canal cholesteatoma. The patient underwent a trans-canal facial nerve decompression along with the cholesteatoma removal. Post-operatively, the patient showed marked clinical improvement with the facial palsy reverting to grade II. EACC involving only the vertical segment of the facial nerve can be approached via the trans-canal route, in contrast to the conventional postauricular approach, with a good clinical outcome. To the best of our knowledge, our case pertains to the only case of EACC with complications, managed by trans-canal facial nerve decompression.

Keratosis obturans: A rare cause of facial nerve palsy

Keratosis obturans, caused by the deposition of desquamated keratin plug in the external auditory canal can present with facial palsy. Young patients presenting with facial palsy, earache, and gradual hearing loss should be suspected for Keratosis obturans.

Biochemical composition and antioxidant potential of the edible Mediterranean sea cucumber

The sea cucumber or holothurian is a marine species which has been prized in some Asian coun­tries for its nutritional qualities. The purpose of this work was to study the biochemical composition and free radical scavenging and antioxidant activities of Holothuria tubulosa tegument from the Bizerta lagoon in north­ern Tunisia. The obtained data demonstrated that the extract of sea cucumber teguments exhibited high bio­chemical levels (such as moisture 80.77%, protein 7.07%, lipids 10.21%, energy value 13.64 Kcal/g ww), and an important nutritional value (including n-3/n-6: 2.11, EPA+DHA: 20.96, AI: 1.38 and TI: 0.54). High anti­oxidant activities were recorded in the integument by the radical scavenging tests of ABTS and DPPH as well as by the total antioxidant capacity and the FRAP in comparison with the BHT standard. Our results showed that H. Tubulosa tegument has high nutritional value with high antioxidant activities and could be considered a nutraceutical product.

A Wolf in Sheep's Clothing: Keratosis Obturans Causing Facial Nerve Palsy - A Case Report with Review of the Literature

Keratosis obturans is a benign disease caused by layered impaction of wax within the external auditory canal. It presents with acute onset of pain and ear blockade. The current report discusses a 24-year-old male patient with recurrent unilateral keratosis obturans associated with facial canal erosion and resulting in facial palsy. A detailed review of the literature is presented. Keratosis obturans can behave aggressively, resulting in significant erosion of the bone and intratemporal structural damage and complications. Timely intervention is vital.

A Recurrent Misdiagnosed and Maltreated Case of Keratosis Obturans

Keratosis obturans is an obscure entity characterized by accumulation of desquamated keratinous material in the bony portion of the external auditory canal. Patients with this condition typically present with severe otalgia, conductive hearing loss, and global widening of the external auditory canal. We present a case of keratosis obturans that was misdiagnosed as impacted wax. The case was diagnosed and managed by microscope-guided examination with the patient under general anesthesia.

Temporal bone imaging

Temporal bone imaging is performed for a variety of clinical conditions addressed in the outpatient and acute care setting ranging from hearing loss to trauma. Recent advances in magnetic resonance technology have enhanced the assessment of fine anatomic temporal bone detail and improved the diagnostic sensitivity for important pathology. For example, non-echo planar diffusion weighted imaging increases detection rate and diagnostic confidence of recurrent cholesteatoma. This chapter will focus on relevant temporal bone clinical entities and new MR developments that have come into clinical practice.