OtoRhinoLaryngology Portal

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Aural Polyp


    Polyp from middle ear emerging             Polyp arising from external surface

      through an eardrum perforation.                      of posterior pars tensa.

Granulation polyp (arrow) involving posterior quadrant of pars tensa. 

[X - umbo, (+) - lateral process of malleus. 

Granulation polyp arising from left pars flaccida (arrow).


Polyp arising from umbo area which resulted in blood-stained discharge and impaired hearing.

Round-shaped granulation polyp (+) with adjacent earwax seen just beyond.

   Polyp filling osseous ear canal with blood-stained discharge.

 Fleshy polyp passing through a medium-sized perforation

[before & after ear toilet].


An inflamed sessile middle ear polyp (circle) in a patient with chronic suppurative otitis media with underlying chronic mastoiditis.  [A - anterior, I - Inferior, S - superior, + malleus remnant, interrupted black line - edges of subtotal perforation]  

Middle Ear Polyp: Blunt Probing


Images shows a true polyp arising from middle ear mucosa.  Probing with blunt ring curette reveals its origin from the malleus handle supriorly (yellow arrow). Polypectomy by snaring or by using sharp instrument is preferred rather than by avulsion technique as to avoid potential ossicular injury.

[green arrow- facial nerve, dotted dark blue circle- round window niche, light blue circle- eustachian tube opening, dotted red- eardrum perforation margin]

Hyperplastic middle ear mucosa with a polyp arising from the promontory.

Ear Polyp Removal

Snare device suitable to be used for pedunculated granulation/polyp or those

with thin pedicle arising from external ear canal.  Temporary brisk bleeding

is to be expected and can be controlled with topical adrenaline pack.

Primary External Ear Canal Cholesteatoma


 Pre-aural toilet of the the same patient below.

Cavity involving the floor of cartilaginous auditory meatus filled with keratin (rounded rectangle).  Bone sequestrum was also removed along with the keratin flakes from this crater earlier.  Normal tympanic membrane is seen beyond (TM).

Congenital Cholesteatoma

Dullness and opacity involving the pars flaccida

and posterosuperior segment of the pars tensa.

Close-up view of the same patient's eardrum. (X - cholesteotoma materials).

White epithelial pearl arising from attic with an intact tympanic membrane.

Congenital Cholesteatoma with Attic Involvement

Visible whitish hue deep to posterior pars tensa secondary to

congenital cholesteatoma which has finally eroded the attic region.

Serial images displayed to demonstrate its clinical progression over times

before surgical intervention undertaken.

Close-up view of keratin flakes.

Secondary External Auditory Meatus Cholesteatoma with False Tympanic Membrane Formation

 A completely obstructed ear canal with a bulging tense membrane.


A close-up view of the above lesion.

Arrow - keratin material filling the ear passage till true ear drum, stars - false tympanic membrane.

Postero-Superior Pars Tensa Retraction

Segmental retraction (outlined) which potentially predisposes to deranged epithelial migration and potential formation of secondary-acquired cholesteatoma.

Pars Tensa Retraction Pocket with Secondary Acquired Cholesteatoma 

Cleft palate with resultant eustachian tube dysfunction predisposes to severe atelectasis and retraction pocket formation which complicates

into secondary acquired cholesteatoma.

Cholesteatoma: Bulging of Posterior Eardrum Segment

Postero-marginal Perforation with Polyp in Cholesteatoma

 A similar lesion involving the right ear.   The patient presented with scanty foul-smell ear discharge, dizziness, reduced hearing and headache.  The eardrum appeared severely retracted with granulation seen at the periphery posteriorly and yellow pus in proximity.  Fistula test was found positive! 

Attic Granulations in Cholesteatoma

Attic Erosion with Auto-atticotomy due to Cholesteatoma

[TM- tympanic membrane, white dot- umbo]

Attic Polyp in Cholesteatoma

               Before ear suctioning                               After ear suctioning


Attic polyp should raise the possibility of underlying cholesteatoma. 

Proper ear toilet should be performed and particular attention paid to attic region.  Cholesteatoma flakes can be seen as cheesy white material.

Cholesteatoma: Unusual Type

Cholesteatoma: Post-Surgery Images

Curvi-linear scar over the incisura area.

Fine healed post-auricular curvilinear surgical scar.

Wide meatoplasty.

Intact right malleolar-incudal complex in the epitympanum after

healed cholesteatoma surgery. Posteriorly leads to aditus ad-antrum.

View of epithelialized postero-superior cholesteotoma after ear toilet performed.

Healed atticotomy cavity and cholesteatoma-free.

Figure shows epitheliazed post-atticotomy cavity

with some earwax cumulation superiorly.

The epitympanum view after ear toilet showing missing

head of malleus with its adjoining body of incus.

 Figure shows the facial nerve (arrow) course in the middle

(horizontal segment) before it turns inferiorly as the

vertical segment a patient who had surgery perfomed for atticoantral disease.

 Horizontal segment of facial nerve (arrow)

 A clean mastoid cavity.


Figure shows a well-epithealized mastoid cavity after a canal wall down surgery.

Mastoid cavity with epithelial crusts and some earwax.

Figure shows a localized entrapped keratin (arrow) 

in a patient who had canal wall down surgery for cholesteatoma. 

Early recurrence of cholesteatoma in a mastoid cavity manifested as epithelial pearls (arrows).  (TM - tympanic membrane, A - anterior, P -posterior)

Ear Inspection and Toilet of Mastoid Cavity

Follow-up assessment and inspection serve several objectives:

i. To monitor healing and recovery.

ii.To clean the cavity from epithelial debris or earwax cumulation.

iii.To detect and treat concurrent infection e.g. otomycosis.

iv.To diagnose residual or recurrence disease and plan for further therapeutic intervention.


Another example showing crusts (arrow) in a well-epitheliazed cavity.


Otomycosis occuring after cholesteatoma surgery.

Paediatric Cholesteatoma Surgery

Sequential endoscopic images of right auditory meatus showing post-surgery changes in a 4 year old child who had cholesteatoma operation 2 years earlier.  Except for the hearing loss, she is otherwise asymptomatic.

Epithelial Migration of The Mastoid Cavity Epithelium

 (Epithelial migration figures are courtesy of Dr G Revadi)

Bony Anatomy of Temporal Bone after Mastoidectomy

1- squamous portion, 2- zygoma, 3- mastoid portion, star- mastoid tip,

red arrow- tympanic plate, blue arrow- parietal notch.