Archives of Medicine and Health Sciences

CASE REPORT
Year
: 2015  |  Volume : 3  |  Issue : 2  |  Page : 320--322

Trichogranuloma of the external auditory canal mimicking aural polyp: A rare case report


Bushra Siddiqui1, Shahbaz Habib Faridi2, Shaista M Vasenwala1, Hena Ansari1,  
1 Department of Pathology, JN Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
2 Department of Surgery, JN Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

Correspondence Address:
Shahbaz Habib Faridi
Department of Pathology, JN Medical College, Aligarh Muslim University, Aligarh - 202 002, Uttar Pradesh
India

Abstract

We report a case of an 18-year-old male who presented to us with complaints of decreased hearing, ear discharge, and fullness in the right ear for last 2 months. Examination revealed a swelling of 0.5 cm × 0.5 cm in the inferior part of the external acoustic canal, tympanic membrane was found to be normal. Patient was advised antibiotic and steroids ear drops after making a provisional diagnosis of aural polyp. Surgical excision of the swelling was done when conservative treatment was unsuccessful. The excised polyp was sent for histopathological examination which revealed presence of foreign body giant cells and mixed inflammatory infiltrate around the fragments of hair shafts which confirmed the diagnosis of trichogranuloma in the external auditory canal. Owing to the rarity of such location of trichogranuloma, this case is being reported here.



How to cite this article:
Siddiqui B, Faridi SH, Vasenwala SM, Ansari H. Trichogranuloma of the external auditory canal mimicking aural polyp: A rare case report.Arch Med Health Sci 2015;3:320-322


How to cite this URL:
Siddiqui B, Faridi SH, Vasenwala SM, Ansari H. Trichogranuloma of the external auditory canal mimicking aural polyp: A rare case report. Arch Med Health Sci [serial online] 2015 [cited 2019 Jul 20 ];3:320-322
Available from: http://www.amhsjournal.org/text.asp?2015/3/2/320/171940


Full Text

 Introduction



Trichogranuloma is a granulomatous dermal reaction due to the traumatic implantation of pieces of hair. The hair in the granuloma is derived from the patient's own hair in the same fashion as occurs in the case of pilonidal sinus of the sacroiliac region. Trichogranulomas have been reported in the interdigital area in barbers as against its name barber's hair sinus or interdigital pilonidal sinus. [1] Hair clippings penetrate the skin of the web space and initiate a foreign body reaction, forming a sinus, and later a cyst or a polyp. [2] The main goal of this paper was to report a rare site of trichogranuloma in the external auditory canal.

 Case Report



An 18-year-old male presented to the outpatient department of otorhinolaryngology with complaints of decreased hearing, sticky purulent discharge, and fullness in his right ear for the last 2 months. There was no history of ringing in the ears, vertigo or earache. He denied ear pricking, trauma or swimming. On otoscopy, there was a pinkish, spherical, pedunculated polypoidal mass of about 0.5 × 0.5 cm arising from the inferior part of the external acoustic meatus, tympanic membrane was found to be normal. Pure tone audiometry was done which revealed 30 dB of conductive hearing loss while the other ear was found to be normal. Schuller's view radiography was done to look for mastoid air cells, which was found to be normal. Provisional diagnosis of aural polyp was made and antibiotic and steroid ear drops and oral antibiotics were prescribed.

Patient was planned for surgical excision when there was no improvement on conservative management. Peroperatively there was a polypoidal swelling arising from the inferior wall of the external acoustic meatus and rest of the findings were same as that on otoscopy. The excised polyp [Figure 1] was sent for histopathological examination.{Figure 1}

 Histopathology



The biopsy specimen was fixed in 10% formalin and embedded in paraffin. The sections were stained with hematoxylin and eosin. Histopathological examination of the polyp revealed the presence of fragments of the hair shaft which was surrounded by foreign body giant cells and mixed inflammatory infiltrate consisting neutrophils, lymphocytes, and plasma cells [Figure 2]a and b].{Figure 2}

The differential diagnoses of acne inversa and perifolliculitis capitis were excluded because of absence of pilosebaceous units in the examined sections, also external auditory canal is not a common site for these lesions. Thus, the diagnosis of trichogranuloma of external auditory canal was made.

 Discussion



An aural polyp may arise from the external ear, middle ear, or adjacent structures such as the parotid and temporomandibular joint. [3] The most common cause of aural polyps in younger age is chronic otitis media with or without cholesteatoma, but these polyps are associated with numerous pathologies ranging from inflammatory to malignant processes. [4] Bearing in mind the more common infectious and inflammatory etiologies of aural polyps, initial treatment is appropriate culture-directed medical therapy. [5] Topical corticosteroid and antibiotic therapy may lead to resolution of an aural polyp associated with chronic otitis media. In other disease processes, conservative treatment is not beneficial, and patient should be evaluated further. An audiogram and computer tomography scan may be of help in making diagnosis in such cases. [6] In the present case report, the otoscopic findings ruled out any pathology of the tympanic membrane and the middle ear. The patient was advised antibiotic drops and oral antibiotics, but he did not improve, so surgery was done, and the polyp was removed and sent for histopathological analysis.

Histopathological examination of the biopsy specimen was, however, suggestive of trichogranuloma of the external auditory canal. Hence, the knowledge of this differential diagnosis is important in avoiding unnecessary delay in diagnosis and potential morbidity.

 Conclusion



This case study aims at reporting a rare case of trichogranuloma of the external auditory canal mimicking an aural polyp. The diagnosis was confirmed after the histopathological examination of the excised specimen. If aural polyp is not associated with any pathology of the middle ear and the tympanic membrane and does not improve with the conservative management strong consideration should be given to additional diagnoses and treatment. Surgical exploration and biopsy may be needed for diagnosis and should be undertaken in a timely fashion to avoid morbidity associated with a delay in diagnosis.

References

1Hogan DJ. Subungual trichogranuloma in a hairdresser. Cutis 1988;42:105-6.
2Patel MR, Bassini L, Nashad R, Anselmo MT. Barber's interdigital pilonidal sinus of the hand: A foreign body hair granuloma. J Hand Surg Am 1990;15:652-5.
3Chatra PS. Lesions in the external auditory canal. Indian J Radiol Imaging 2011;21:274-8.
4Harris KC, Conley SF, Kerschner JE. Foreign body granuloma of the external auditory canal. Pediatrics 2004;113:e371-3.
5Acuin J. Chronic suppurative otitis media. BMJ Clin Evid 2007;02:507.
6Brobst R, Suss N, Joe S, Redleaf S. Bilateral inflammatory aural polyps: A manifestation of samter's triad. Int J Otolaryngol 2009;2009:464958.