Aural masses/polyps of the EAC/middle ear can be due to various causes such as congenital, traumatic, inflammatory, benign, or malignant causes such as otitis media, pyogenic granuloma, and tumors from the eccrine glands of the EAC, relapsing polychondritis, langerhans cell histiocytosis, and neoplastic conditions like osteoma, rhabdomyosarcoma, and progressive necrotizing otitis externa [3]. These aural masses can present as, granulation tissue, aural polyps or growths with persistent ear discharge, ear fullness, ear pain, and hearing impairment [4]. Neglected foreign bodies presenting as a skin-covered mass in the EAC are very few in the literature to date.
Harris et al. in 2004 reported an external auditory canal polyp and retrieved a plastic electrical cap on surgical exploration in a 9-year-old boy [5]. Ahmed et al. removed a spherical bead in a 5-year-old child, and Abdel Tawab et al. removed neglected cotton pieces in a 19-year-old deaf-mute patient, the above described cases presented as external auditory canal mass which failed to respond to adequate medical management [3, 6] and the patients were subjected to appropriate imaging and still failed to reveal the foreign body.
Clinical diagnosis and treatment of the EAC mass are based largely on history, examination, and appropriate investigations. HRCT of the temporal bone helps in diagnosis and specifically determines the extent of the lesion involving the EAC, middle ear, and inner ear. It also provides a tool for better evaluation of the surrounding structures, and it is considered the best method to visualize the middle ear when there is complete occlusion of the external auditory canal [1]. In our case, the HRCT temporal bone did not reveal the presence of a foreign body; hence, we proceeded to FNAC.
FNAC is also another tool that gave us an idea of underlying pathology by identifying the tissue of origin and its nature; as in our case, it was revealed to be an inflammatory aural polyp [2].
In our case, our patient was unsure of the mode of onset of trauma to her left ear at work despite adequate history taking, so we proceeded with appropriate investigations to find out the cause, and to rule out the presence of a retained foreign body, an HRCT temporal bone was done.