This paper reports a case series of three elderly patients who were regularly attending ENT clinic every four to six weeks for ear canal care to address chronic otitis externa. All three patients had been taking bisphosphonate alendronic acid for years, and it is suspected that this drug was partly to blame for the progression of their chronic ear conditions.

Some improvements were noted when the bisphosphonate was discontinued. The regular microsuctioning, and application of topical antibiotics with steroids, provided temporary relief of symptoms. The present pandemic shut down the routine clinic and the patients were not seen for four to five months. On latest review, it was a surprise to see that their ears seemed to have significantly improved, with healthy re-epithelialisation.

It is thus believed that excessive and repeated microsuctioning in bisphosphonate-induced osteonecrosis of that external ear canal can delay re-epithelialisation, and gradually prolonging the intervals between microsuctioning could help in overall resolution of the disease.

Eczematous external otitis is a common chronic condition that can have a significant impact on the life of sufferers, causing constant discomfort and pruritus, and leading to sleep deprivation. Treatment is based on the use of topical steroids, moisturisers and occasionally antibiotics. Results, however, can be disappointing, especially over the long term.

This study compared the long-term response to pimecrolimus, administered to a group of 11 patients, against clobetasone butyrate, administered to an equivalent number of patients. Response to the treatment was assessed and statistically analysed at 3 and 12 months.

Whereas the degree of improvement following the use of pimecrolimus and clobetasone butyrate was similar for the two groups at month 3, a highly statistically significant difference was documented at month 12, with a much greater and sustained improvement in the pimecrolimus group.

To perform a validation assessment of a novel porcine ex vivo model for otoplasty training.

A total of nine otolaryngology trainees performed a standard approach otoplasty on a porcine ear. They completed a series of tasks including posterior skin incision, anterior scoring, Mustardé suture placement and concha–mastoid suture placement. Trainees completed a post-task questionnaire assessing face validity, global content validity and task-specific content validity.

Trainees’ median scores for the porcine model were: 4 for face validity (interquartile range, 3–4), 5 for global content validity (interquartile range, 4–5) and 4 for task-specific content validity (interquartile range, 4–4).

This study is the first to formally validate the ex vivo porcine auricular model as a useful tool for training in otoplasty. The model should be incorporated into simulation training for otoplasty in order to improve learning, enable acquisition of specific surgical skills and improve operative outcomes.

Direct extension of an intracranial meningioma to involve the temporal bone is rare. Recognised sites of origin and routes of access to the middle ear and labyrinthine apparatus have been described. Direct spread through the temporal bone to primarily involve the external auditory canal has not been widely reported in the literature.

This paper discusses clinical and radiological findings in three cases of temporal bone meningioma presenting as masses within the external auditory canal.

Diagnosing temporal meningioma can be challenging because of its rarity and the often non-specific clinical and histological findings. It is important for both the surgeon and radiologist to be aware of the diagnosis and its related imaging findings in order to facilitate a timely diagnosis.

To compare anatomical and audiological results using sliced tragal cartilage and temporalis fascia in type I tympanoplasty.

A retrospective review was undertaken of primary tympanoplasties using sliced tragal cartilage and temporalis fascia from May 2005 to January 2008. In total, 223 ears were operated on using sliced tragal cartilage graft and 167 using temporalis fascia. Statistical analysis of the outcome data was performed.

At the two-year and four-year follow ups, successful closure of the tympanic membrane was achieved in 98.20 per cent and 97.75 per cent, respectively, of the cartilage group compared with 87.42 per cent and 82.63 per cent, respectively, of the temporalis fascia group. At the four-year follow up, the average air–bone gap was 7.10 ± 3.01 dB in the cartilage group and 8.05 ± 3.22 dB in the temporalis fascia group.

The overall success rate for primary cartilage tympanoplasty is higher when using sliced cartilage than with temporalis fascia grafting.

Leishmaniasis comprises a group of diseases transmitted by the bite of infected sand flies. There are three basic clinical forms of leishmaniasis: cutaneous, mucocutaneous and visceral. Leishmaniasis may mimic neoplastic lesions and other infectious diseases because of similar disease localisation, physical characteristics and histopathological findings.

A 35-year-old man was referred to our clinic with a presumed diagnosis of angiolymphoid hyperplasia of the auricle; however, this lesion proved to be cutaneous leishmaniasis. The definitive diagnosis was reached by identifying the parasites on smears obtained from the lesion.

It should be borne in mind that cutaneous leishmaniasis presenting as isolated auricular lesions may mimic neoplasia. In the present case report, we discuss auricular cutaneous leishmaniasis and we review the relevant literature.

To study the role of mitomycin C in reducing keloid recurrence.

Prospective, randomised, controlled trial.

Tertiary care referral centre.

Case series of 20 patients presenting with 26 pinna swellings, mostly following ear piercing.

We used the technique of surgical shave excision combined with topical application of mitomycin C and secondary wound healing, in all 26 pinnae.

Patients were followed up six to 24 months post-operatively. No recurrences were noted during this period.

Keloids are fibrotic lesions resulting from abnormal wound healing. The uncontrolled proliferation of normal tissue healing processes results in scarring that enlarges well beyond the original wound margins. Successful treatment of keloids remains a challenge because this disease process has a high propensity for recurrence. Various therapies have previously been reported, and success rates are highly variable. We believe that shave excision followed by topical mitomycin C application is a promising treatment option for the management of pinna keloids.

After excision of a preauricular sinus, a head bandage compressive dressing is usually used to reduce dead space and to decrease the risk of recurrence. However, such use of a head bandage may cause various problems. We assessed a new method of compressive dressing, using suture transfixion of silicone sheets to the former sinus tract, following preauricular sinus excision.

This retrospective study reviewed the medical records of patients undergoing preauricular sinus excision in a tertiary referral centre over a five-year period. After excision of the preauricular sinus, patients underwent suture transfixion of silicone sheets. Post-operative outcomes were analysed.

The new dressing method was performed on 50 ears of 37 patients. The post-operative incidence of recurrence and haematoma formation was 4 and 2 per cent, respectively. Other problems possibly caused by head bandaging, such as headache, facial flushing, and nausea and/or vomiting, were not observed.

Compressive dressing by suture transfixion of silicone sheets is safe and effective following preauricular sinus excision.

We report a rare case of auricular involvement by leishmaniasis, in order to demonstrate the importance of thorough investigation of cutaneous head and neck lesions, and also the importance of inclusion of infections such as leishmaniasis in the differential diagnosis of auricular lesions, especially in endemic areas.

A 42-year-old man with multiple lesions on his head, neck and hands was referred to our centre. He had the following lesions: a painful, crusted, 8 × 8 cm plaque with indurated margins on the left parotid region and auricle; a red papule on the right temporal region; an ulcerative lesion on the skin overlying the proximal interphalangeal joint of the fifth finger of the right hand; and a bluish papule on the neck. Although histopathological examination of the Geimsa-stained specimen was misleading, a direct smear prepared from biopsies showed amastigotes, and therapy resulted in complete recovery.

Leishmaniasis can be both under- or over-diagnosed. Especially in endemic areas, parasitic causes of chronic infections should always be kept in mind.

We report a rare case of otophyma.

A case report of otophyma and a review of the current literature concerning otophyma and the more common rhinophyma, are presented.

A 46-year-old male presented with slow growing fleshy growths on both auricles which were excised. A diagnosis of otophyma was made. Although rosacea is more common, otophyma and other ‘phymas’ are thought to be the end stage of the rosacea spectrum of skin disease. However, unlike rhinophyma, otophyma is rarely seen and as a result there is little in the English language literature regarding it. Consequently, the management of otophyma is largely based on previous experiences with rhinophyma.

To our knowledge this is the first case report of otophyma in the otolaryngology literature and only the second described in the English language literature. This case demonstrates the difficulties faced in diagnosing this rare condition and our successful management of this case.