2021 Volume 64 Issue 1 Pages 19-24
We report a rare case of isolated subcutaneous emphysema in the external auditory canal. The patient was a 15-year-old boy who presented with the complaint of his left ear pain/ear block when he sneezed or blew his nose. He visited a local clinic, was prescribed antibiotics, and showed temporary improvement. However, his condition deteriorated again, and he was referred to our department. Examination revealed narrowing of the left external ear canal caused by swelling of the skin covering the ear canal. CT revealed a large number of air bubbles in the subcutaneous tissue of the left external auditory canal, some defects and thinning of the bony wall of the left external ear, and the mastoid with poor growth on the left side as compared to the right side. We made the diagnosis of subcutaneous emphysema of the external auditory canal, and punctured and suctioned the swollen area and packed the ear canal with gauze; we also prescribed prophylactic antibiotics to prevent infection of the area.
We speculate that the pressure in the middle ear cavity increased via the Eustachian tube when the patient sneezed or blew his nose, compressing the subcutaneous tissue in the external ear canal through the mastoid, eventually causing subcutaneous emphysema in the external auditory canal. We think that two major factors were operative in our case; one was the immaturity of the Eustachian tube in childhood which interfered with its protective effect against increase of the middle ear pressure and the other was the anatomical peculiarity of the left stunted mastoid cells with defects and thinning of the bony wall of the left external ear.
We think that the initial treatment for such a case should be conservative, with follow-up under systemic/topical antibiotic therapy, puncture, suction and press with gauze on the swollen area. In patients presenting with recurrence despite the aforementioned measures, incision of the skin over the swollen area, insertion of an eardrum ventilation tube, or even reconstruction the external auditory canal bone wall may become necessary.
