Seborrhoeic Keratosis; A Rare Cause of Conductive DeafnessCorrespondence Address :
Dr. Shrinath D Kamath P,
Assistant professor,Department of Otorhinolaryngology,
KS Hegde Medical Academy, Deralakatte,
Mangalore, Pin-574160, India.
Seborrhoeic keratoses is commonly seen in the head and neck region, but it rarely causes functional impairment. When it is present at the external auditory canal, it can cause conductive hearing loss, which needs to be corrected by excision. We are presenting a successfully treated case of seborrhoeic
keratoses of the external auditory canal with a conductive hearing loss.
Seborrhoeic keratoses ;external ear; conductive deafness.
Seborrhoeic keratoses are benign epidermal neoplasms which afÂ¬fect elderly people. They cause cosmetic disfigurement, especially when they occur on the face. Usually, their number is limited, but on rare occasions, they appear suddenly in large numbers and are associated with itching. Such a condition is termed as a Lesser Trelat sign, which is thought to be a cutaneous marker for an inÂ¬ternal malignancy (1). We are reporting here a case of large sebÂ¬orrhoeic keratosis of the external ear, which caused conductive deafness.
A 62-year old female patient presented to skin department with complaints of lesions in the left pinna and on the face. The lesion in the pinna was the first to appear 10 years ago, which had started as a small area of colour change on the concha, about the size of a pin head and it had gradually increased in size as well as in thickness. She developed facial lesions 2 years ago, which were also solid lesions. No associated symptoms were noted. She also complained of hearing loss in the left year since 1 year. No other significant medical or surgical history was noted. On examination, a hyperpigmented verrucous plaque which involved the medial surface of the tragus, the inter tragal notch, the antitragus, the medial half of the concha, the anterior wall and the floor and the posterior wall of the cartilaginous part of the external auditory canal was observed, which was found to cause complete obliteration of the external auditory canal on the left side. Multiple, hyperpigÂ¬mented, verrucous plaques and papules were present on both the cheeks, which had a stuck on appearance [Table/Fig 1] a & [Table/Fig 1] b. Tuning fork tests revealed a conductive hearing loss of about 512Hz, which was confirmed by a pure tone audiogram ( 40 dB). An incision biopsy of the ear lesion was done and it was sent for histopathological studies. The histopathological examination reÂ¬vealed hyperkeratosis, papillomatosis, acanthosis and pseudohorn cysts which were suggestive of acanthotic seborrhoeic keratosis [Table/Fig 1] c. The lesions on the pinna and the external auditory canal were excised with a diode laser under local anaesthesia and the raw area was allowed to heal by secondary intention . FollowÂ¬ing the excision, there was a dramatic improvement in the patientâ€™s hearing and after 6 months of follow up, the patient did not show any signs of recurrence.
Seborrhoeic keratoses commonly appear in the head and neck region. The variants of seborrhoeic keratoses include dermatitis papulosa nigra, stucco keratoses and melano acanthoma (1). The occurrence of seborrhoeic keratoses (melanoacanthoma) in unÂ¬usual sites like the genital and perianal areas has been reported (2). Our patient had seborrhoeic keratosis which was situated in the pinna, with an extension to the external auditory canal. Though cosmetic disfigurement is the main symptom, on rare occasions, they can cause functional impairment, as in our patient. At the onÂ¬set of the lesion, our patient did not have any hearing loss. When the lesion acquired sufficient size, it acted like a space occupying lesion to cause obstruction of the external auditory canal, leading to conductive hearing loss. As these lesions can be easily removed by electro-cautery/radio-surgery/shave excision, the removal of the same will result in improvement in the patientâ€™s hearing. There are reports of basal cell carcinoma, squamous cell carcinoma and melanoma which were associated with seborrhoeic keratosis (3). The suspicious lesions should be subjected to a biopsy and they should be sent for a histopathological evaluation.
Seborrhoeic keratosis of the external auditory canal which leads to conductive hearing loss is very rare and it can be successfully treated with laser excision.
Date of Submission: Nov 20, 2011
Date of peer review: Mar 29, 2012
Date of acceptance: Mar 30, 2012
Date of Publishing: Jun 22, 2012
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)