Osteomas are considered bony neoplasms that show a predilection for the external auditory canal (EAC), mastoid cortex, facial bones, and mandible. Surgical excision is the standard treatment for EAC osteomas, however close observation is considered acceptable in asymptomatic patients. Debate remains in the medical literature as to whether basic histopathology can distinguish osteomas of the EAC from exostoses. While they share similarities, more often than not it is possible to distinguish the two bony neoplasms based on clinical history and radiographic studies. Osteomas have historically been compared and contrasted with exostoses of the EAC. Histopathologically, EAC osteomas are covered with periosteum and squamous epithelium, and consist of lamalleted bone surrounding fibrovascular channels with minimal osteocysts. Computed tomography reveals a hyperdense, pedunculated mass arising from the tympanosquamous suture and lateral of the isthmus. Osteomas of the EAC are usually found incidentally and are unilateral and solitary. Diagnosis is made based on a combination of clinical history and examination, radiographic imaging, and histopathology. Symptoms are rare and can include hearing loss, vertigo, pain and tinnitus. While chronic irritation and inflammation have been suggested as causal factors in several cases, significant data is lacking to support these suspicions. External auditory canal (EAC) osteomas are rare, benign bony neoplasms that occur in wide range of patients.
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