Granulation of Tympanic membrane


The ear tube granuloma or granulation tissue occurs when the eardrum squeezes out the ear tube. This results in bleeding and drainage. The reason could be either the inflammation of outer epithelial layer of tympanic membrane or the spreading of the granulation tissue formed in the middle fibrous layer causing the epithelial layer of tympanic membrane to proliferate and the granulations are formed. The tympanostomy-tube-related granulation tissue can also occur. Granulation tissue might also arise as a direct response to the presence of the foreign body in the tympanic membrane sometimes ear implants, or trapped squamous epithelium between the flange of the tube and the tympanic membrane.

A specific form of otitis externa, called Granular myringitis (Myringitis granulosa) is characterized by the presence of granulation tissue on the lateral part of the ear drum and sometimes the external auditory canal. The macerated dermis has the tendency to grow into the injured tissue, which later becomes the main sources of inflammation. The inflammation of the mucous membrane forms granulation tissue and polyps. Purulent secretions on removal reveal the underlying granulation tissue. Granulations can be either localized or diffuse. The most common are localized form of granulations in which small areas of the drum are affected. These granulations are common over the postero-superior margin of the ear drum. These granulations may also affect the adjacent wall. The ear drum is intact even with all these signs. When granulation tissue is present, it is removed with micro instruments or cauterization with silver nitrate sticks by an ear surgeon.

Keloid


Keloids are an abnormal response to wound healing distinguished by an overproduction of collagen. A keloid is a type of scar which, is composed mainly of either type III (early) or type I (late) collagen. The granulation tissue (collagen type 3) get overgrow at the site of a healed skin injury which is then slowly replaced by collagen type 1. Keloids are rubbery lesions or shiny firm or fibrous nodules, and can vary from pink to dark brown in color. A keloid scar is benign and not contagious, but sometimes it cause severe itchiness and pain, accompanied by changes in texture. In severe cases, it can affect movement of skin. Keloids affect both sexes equally, but due to the greater frequency of ear piercing among women, incidence of keyloid ear in young female patients is higher than in young males. Keloids can develop in any place where an abrasion has occurred. They can be the result of pimples, insect bites, scratching, burns, body piercings, and skin trauma or post surgery. They are more common in some sites such as the central chest, the back and shoulders, the ear lobes, arms, and over the collar bone. They rarely develop on the face. Changes in the cellular signals that control growth and proliferation may be related to the process of keloid formation. For a person who has formed one keloid may have to avoid any elective surgery or piercing, especially in body areas prone to scarring to get rid of a keloid.

Narrow External Auditory Canal with Osteoma


Osteomas are the most common benign bony neoplasm of the temporal bone, usually pedunculated lesions often develop in the external auditory canal on squamous sections. They consist of fibrovascular tissues covered by a layer of disorganized bony tissue. It usually occurs as a solitary mass, often in a bony suture line. They often cause obstruction of the ear canal and eventually hearing loss. Repeated exposure to cold water may increase the risk of benign tumors of the ear canal. A stenotic ear canal occurs when the canal leading from the external ear to the middle ear is abnormally narrow. In some cases, the stenotic ear canal becomes so narrow that it can cause hearing loss. In addition to chronic inflammation of ear canal, an osteoma within the ear canal also leads to an abrupt narrowing of the canal. Due to the slow growth, auditory canal osteomas develop asymptomatically for a long time without any characteristic clinical features. In most cases, they are discovered accidentally during otoscopic or radiographic examination. The method of choice in diagnosis is temporal bone CT scan. Benign bony tumors may progressively increase in size. If a benign tumor is painful, interferes with hearing, or leads to frequent ear infections, surgery to remove the tumor may be necessary.
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