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Have dermoid cyst in the ear canal. History of mastoid surgeries. Any diagnostic tests to know the extent of the spread?

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My husband has a large dermoid cyst in his ear canal. The dr wants to use a local and remove it in the office. The whole canal is occluded by the cyst and we are concerned that it may have extensive roots or come back at a later date. It is the same ear that he had many surgeries on and behind the ear for mastoids50 years ago. Are there any diagnostic tests that can be done to show the full extent before we consent to the in office procedure and what number have to be reicised. It sounds very painful to me. Thanks for any info you can impart.
Posted Wed, 30 May 2012 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Sumit Bhatti 9 hours later
Hi,

Thank you for your query.

1. Given his history, you should insist on an MRI Temporal Bones and an HRCT (High Resolution CT) Temporal bones. You may discuss with your physicians and refer them to a paper that I have co-authored in Indian Journal of Otolaryngology and Head & Neck Surgery, December 2011: Role of Magnetic Resonance Imaging in Cholesteatoma: The Indian Experience. The true extent of the lesion will be revealed and surgery can be planned accordingly.

2. Request a biopsy. You have to rule out other types of lesions and the rare cancer esp. since he has had multiple surgeries.

3. I must emphasize that a dermoid cyst is usually a benign lesion and there is no need to rush into surgery.

4. You may share your investigation and progress reports here for more specific treatment and rehabilitation options.

I hope I have answered your query. If you have any follow up queries, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Have dermoid cyst in the ear canal. History of mastoid surgeries. Any diagnostic tests to know the extent of the spread? 10 hours later
Dear Dr. Bhatti,
Thank you for your answer. I had queried you also about the return rate of these dermoid cysts in the ear canal. How extensive can the roots be? Our concern is of a great magnitude as my husband is an audio engineer by trade and he is very worried that the root system of the cyst con be entangled with possible auditory nerves. We will insist on the two tests you suggested and also the biopsy. Thanks in advance.
 
 
Answered by Dr. Sumit Bhatti 1 hour later
Hi,

Thank you for writing back.

1. Recurrence will occur if the excision is incomplete. The overall recurrence rate is low. When such lesions entrap important structures, complete excision may not be possible.

2. Since he has had multiple surgeries, the roots may be multiple and extensive.

3. The extent and relation to important structures will show up on the imaging.

4. I assume that the other ear is normal. In such situations, if hearing is damaged, a Bone Anchored Hearing Aid may be of help.

5. You may share your investigation and progress reports here for more specific treatment and rehabilitation options.

I hope I have answered your query. If you have any follow up queries, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
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