Learning Objectives:

We present our experience of Ten cases of EAC cholesteatoma treated in a UK district general hospital (serving a population of approximately 275,000) between 2007 and 2014. We discuss the clinical presentation, appropriate investigation, and subsequent surgical management of these cases. Cholesteatoma of the external auditory canal is rare, but has potential for serious complications such as erosion into the temporo-mandibular joint, facial nerve, and skull base. The most common presenting symptoms were unilateral otorrhoea and otalgia. Clinical findings included erosion of the inferior aspect of the bony canal wall, with accumulated keratin and bony sequestrum. Computed Tomography confirmed the presence of bony canal wall erosion, with an overlying soft-tissue attenuation mass in most cases. The middle ear was normal in most of cases. Examination under anaesthesia and biopsy of the EAC lesion was used to differentiate between EAC cholesteatoma, necrotising otitis externa, and squamous cell carcinoma of the EAC skin. Histological analysis of biopsy specimens showed keratin, with no evidence of malignancy. In each case, the disease was at a relatively advanced stage with erosion of the petrous temporal bone. Bony canalo-meatoplasty was done via a post-auricular approach. The cholesteatoma was excised, and the resulting cavity was filled with grafted tragal cartilage and perichondrium or temporalis fascia to achieve a smooth, self-cleaning ear canal.