External canal cholesteatoma.

OBJECTIVE External canal cholesteatoma (ECC) may develop spontaneously or as a consequence of infection, trauma, or surgery. There is little information on the relative incidence of ECC according to cause. An analysis of cases was conducted to compare the clinical, surgical, and radiographic features of different types of ECC. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS All patients with cholesteatoma of the external auditory canal. INTERVENTION Treatment was variable, ranging from local debridement and topical antibiotics to tympanomastoidectomy. MAIN OUTCOME MEASURE Assignment of cause is based on the combination of clinical history, physical examination, and radiographic appearance. RESULTS A total of 39 patients were reviewed, 5 of them with bilateral lesions. The cause was iatrogenic in 15, spontaneous in 13, trauma in 6, congenital in 2, postinflammatory in 2, and postobstructive in 1. Surgery was performed in 25 cases. Successful results were obtained in most patients. CONCLUSION The cause of an ECC is determined on the basis of clinical features and radiographic appearance. The treatment plan is influenced by the cause of the ECC. Surgery is frequently necessary in congenital, posttraumatic, postobstructive, and iatrogenic ECC. Spontaneous lesions are usually controlled with office debridement.