Alternative Names: Ear canal polyps.
What Is Going on in My Body? Aural polyps are benign, fleshy growths that arise from the skin or glands of the external ear canal or from the surface lining of the tympanic membrane. They can also be a manifestation of cholesteatoma (benign ear skin cyst). Aural polyps usually form from chronic irritation of the skin of the ear canal or eardrum. This chronic irritation is most commonly caused by infections (chronic otitis externs). The major concern with ear canal polyps is the possibility that they may represent a skin cyst in the mastoid or middle ear. These skin cysts although benign erode bone in the mastoid or the ear canal. If they are coming from the middle ear or mastoid and erode through the bone of the ear canal, it can then show up as an ear canal polyp. It is vitally important not to try to remove polyps arising from these skin cysts because they could be attached to some of the small bones for hearing. Ear canal polyps can also represent a variety of benign or malignant growths. They may also be a manifestation of malignant otitis externs (see malignant otitis externs), which is an infection of the bony ear canal and is most commonly seen in individuals with diabetes or who have abnormalities in their immune system. Malignant otitis externs is not a true malignant process but a bone infection that behaves aggressively. It can extend into the mastoid, and left unchecked can create brain abscess, facial paralysis, deafness, meningitis, and bone infection of the base of the skull termed osteomyelitis. One of the early findings in malignant otitis externs is an ear canal polyp typically arising from the bottom inferior part of the ear canal.
What Are the Signs and Symptoms? The primary signs and symptoms relate to the underlying infectious problem. Often there is pain and itching in the ear canal, and there may be some infected drainage. Because the ear canal has a growth in it, it prevents sound from getting to the eardrum, and therefore hearing loss may occur.
What Are the Causes and Risks? The main cause of ear polyps, as mentioned above, is an infectious process. This can either be acute, as is sometimes seen with swimmer’s ear (see acute otitis externs), but is more likely a result of chronic infection that can either be bacterial or fungal. Cholesteatoma usually forms from chronic eustachian tube dysfunction. They may also result from a chronic reaction to a tube placed in the eardrum.
How Is It Diagnosed? A polyp or fleshy growth will be present in the ear canal upon examination. There is usually pus if the primary cause is chronic infection. Polyps of infectious origin are usually soft, red, and bleed very easily when touched, and usually arise from the eardrum or canal. If the polyp is more firm and does not bleed, then a tumor must be considered and the polyp biopsied. Polyps from cholesteatoma usually arise adjacent to the drum in the upper posterior part of the ear canal, bleed easily, have some surrounding pus, and may contain white, glistening debris (keratin). Polyps from malignant otitis externs often arise from the floor of the ear canal, have adjacent pus, and are associated with pain. Since infectious polyps are usually smooth-surfaced, polyps that are irregular or granular usually represent a carcinoma.
What Are the Long-Term Effects? Benign infectious polyps arising from the ear canal may enlarge, bleed, and impair hearing until they are treated. Since cholesteatoma is an expanding benign process, it can create extensive damage to the inner and middle ears and can have disastrous infectious complications. It must not be observed but be surgically removed. Benign growths may predispose to ear canal infections and hearing loss until they are removed. Malignancies must be resected. Malignant otitis externs will continue to spread unless treated (see malignant otitis externs).
Am I Putting Others at Risk? No.
What Are the Treatments? Topical steroid and antibiotic ear drops will resolve most cases of infectious ear canal polyps. For chronic or recurrent infections, steroid creams and white table vinegar (5% acetic acid) is very beneficial. Antifungal drops and creams are used if the problem arises from fungal infection. Non-infectious masses must be biopsied their treatment will be based on their diagnosis. Polyps from ear tubes may require tube removal if drops are not effective. Cholesteatoma-generated polyps initially require drops and oral antibiotics to resolve the infection of the keratin which has caused the polyp. A CT scan helps to clarify its extent prior to its surgical removal. Malignant otitis externa is covered in greater detail under its own heading.
What Are the Side Effects to the Treatments? Since antibiotic/steroid drops are used for infectious polyps, the side effects are specific to those medications. Neomycin is commonly used in topical therapies. Some individuals develop an allergic reaction to it that can cause severe itching, blistering, redness, and thickening of the ear canal skin. It must be stopped if these symptoms develop. For benign tumors, there should be few, if any, side effects upon their removal except pain and bleeding. The side effects from malignant tumor removal are predicated on the extent of the tumor and what other important structures are involved. Refer to benign ear cyst and malignant otitis externa for further discussion of these entities.
What Happens After Treatment? The infection and its polyp should resolve with therapy and have no long-term effects. However, if chronic ear canal infection/inflammation should occur, then some maintenance steroid drops, vinegar irrigations, or antifungal agents may be necessary. If a tube caused the polyp and had to be removed, then another tube of a different material may be required if the middle ear infection recurs.
How Do I Monitor the Disease? Recurrent symptoms of drainage, hearing loss, bleeding, and itching indicate that the underlying infection/inflammation has reactivated.