title: A histological examination in the cases of initial diagnosis as chronic otitis media with a polypoid mass in the external ear canal.
abstract: OBJECTIVE
  to analyse a large series of patients with initial diagnosis of chronic otitis media (COM) with a polypoid mass in the external ear canal (EAC).
  
  
  METHODS
  185 consecutive patients with COM were evaluated; 75 showed a polypoid mass in the EAC.
  
  
  RESULTS
  In 65 out of the 75 (86.7%) patients, histological examination after mastoidectomy revealed cholesteatoma. In the remaining 10 (13.3%) cases, the histological diagnosis was: glomus tumor, melanoma, mucosal adenoma, fibrous dysplasia, squamous cell carcinoma, adenoma of the endolymphatic sac, encephalocele, and tuberculosis. One patient (glomus tumor) had undergone biopsy of the polypoid mass twice preoperatively and the initial histological diagnosis was "inflammatory polyp". Therefore, we examined the temporal bones with a glomus tumor diagnosis from the temporal bone collection of the House Ear Institute. In 1560 temporal bones, a glomus tympanicum was found in 6. In four cases, the tumor extended to the EAC mimicking a polyp covered by squamous epithelium.
  
  
  CONCLUSIONS
  A significant percentage of polyps in COM may be the tip of an 'iceberg'. CT-scan and MRI techniques may be helpful but not always accurate, and biopsies have certain risks. Increased clinical suspicion may limit misdiagnosis and inappropriate management.
authors.affiliation: 1st and 2nd Department of Otorhinolaryngology, Athens University, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Xenellis
authors.forename: Aikaterina
authors.initials: A
authors.lastname: Mountricha
authors.forename: Pavlos
authors.initials: P
authors.lastname: Maragoudakis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kandiloros
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Assimakopoulos
authors.forename: Fred J H
authors.initials: FJ
authors.lastname: Linthicum
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Nikolopoulos
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D018424:Cholesteatoma, Middle Ear / Q000473:pathology; D002908:Chronic Disease; D003937:Diagnosis, Differential; D004424:Ear Canal / Q000473:pathology*; D004427:Ear Diseases / Q000473:pathology*; D004428:Ear Neoplasms; D005260:Female; D043604:Glomus Tympanicum Tumor / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010033:Otitis Media / Q000473:pathology*; D011127:Polyps / Q000473:pathology*; D055815:Young Adult