The external ear, comprising the auricle and external auditory canal, is susceptible to a variety of diseases that can significantly affect a patient's hearing and overall quality of life. These diseases range from common infections such as otitis externa to rare neoplasms, both benign and malignant. ^[1] The clinical presentation of external ear diseases can be varied, often requiring a thorough diagnostic workup to establish an accurate diagnosis and guide appropriate treatment. ^[2]

Otitis externa, commonly known as "swimmer's ear," is one of the most prevalent conditions affecting the external ear. It is characterized by inflammation of the external auditory canal, often resulting from bacterial or fungal infections. ^[3] Symptoms typically include ear pain, itching, and discharge. While otitis externa is generally managed with topical antibiotics and anti-inflammatory agents, severe or recurrent cases may necessitate further investigation to rule out underlying pathologies such as necrotizing otitis externa, which can be life-threatening if not promptly treated. ^[4]

Neoplasms of the external ear, though less common, present a significant diagnostic challenge due to their varied clinical and histopathological features. Benign neoplasms such as sebaceous cysts and chondromas are often asymptomatic and may be discovered incidentally during routine examinations. ^[5] In contrast, malignant neoplasms, including squamous cell carcinoma and basal cell carcinoma, can present with more aggressive symptoms such as ulceration, bleeding, and hearing loss. ^[6] Early detection and histopathological confirmation are crucial for effective management and improved prognosis. ^[7]

Congenital anomalies of the external ear, such as microtia and atresia, are relatively rare but can have profound implications for a child's development, particularly in terms of hearing and speech. These conditions often require a multidisciplinary approach involving otolaryngologists, audiologists, and plastic surgeons to achieve optimal outcomes. ^[8]

Given the diverse nature of external ear diseases, a comprehensive clinicopathological evaluation is essential for accurate diagnosis and effective management. ^[9] This study aims to provide a detailed analysis of the clinicopathological features of external ear diseases in a tertiary care setting, with a focus on the prevalence, clinical presentation, and histopathological findings of these conditions.

This is a prospective study was conducted at a tertiary care hospital over a five-year period. The study population included 70 patients who presented with symptoms suggestive of external ear diseases and were subsequently diagnosed and treated at the hospital. The study was approved by the institutional ethics committee, and informed consent was obtained from all participants.

Inclusion Criteria:

1. Patients with a confirmed diagnosis of external ear disease based on clinical examination and histopathological evaluation.
2. Availability of complete medical records, including demographic data, clinical presentation, diagnostic tests, and treatment outcomes.
3. Patients who provided informed consent for participation in the study.

Exclusion Criteria:

1. Patients with incomplete medical records or missing data.
2. Patients who did not consent to participate in the study.
3. Patients with concurrent middle or inner ear diseases that could confound the diagnosis of external ear pathology.

Data were collected from patient medical records, including age, gender, clinical symptoms, duration of symptoms, diagnostic methods (e.g., otoscopy, imaging studies), and histopathological findings. Histopathological evaluation was performed on tissue samples obtained through biopsy or surgical excision. The samples were processed using standard histological techniques, and slides were examined by experienced pathologists.

Statistical analysis

Statistical analysis was performed using SPSS software (version 25.0). Descriptive statistics were used to summarize demographic and clinical data. Chi-square tests and t-tests were used to compare categorical and continuous variables, respectively. A p-value of less than 0.05 was considered statistically significant.

The study included 70 patients with a mean age of 45 years (range: 5-85 years). The male-to-female ratio was 1.2:1. The most common clinical presentation was ear pain (70%), followed by hearing loss (50%) and ear discharge (40%). Otitis externa was the most frequently diagnosed condition, accounting for 40% of cases. Benign neoplasms were observed in 30% of patients, with sebaceous cysts being the most common. Malignant neoplasms were diagnosed in 10% of patients, with squamous cell carcinoma being the predominant type.

Table 1: Demographic Characteristics of Patients

Table 2: Gender Distribution

Table 3: Clinical Presentation

Table 4: Distribution of Diagnoses

Table 5: Histopathological Findings in Benign Neoplasms

Sebaceous Cysts were the most common benign neoplasm, accounting for 57.1% of cases. Chondromas were the second most common benign neoplasm, representing 28.6% of cases. Other benign neoplasms constituted 14.3% of cases, which may include conditions such as lipomas, fibromas, or papillomas. 

Table 6: Histopathological Findings in Malignant Neoplasms

Squamous Cell Carcinoma (SCC) was the most common malignant neoplasm, representing 71.4% of cases. Basal Cell Carcinoma (BCC) accounted for 28.6% of malignant cases.

Table 7: Diagnostic Methods Used

Table 8: Treatment Modalities

Table 9: Outcomes of Treatment

Table 10: Complications Observed

The findings of this study highlight the diverse spectrum of external ear diseases encountered in a tertiary care setting. Otitis externa was the most common condition, consistent with previous studies that have reported its high prevalence, particularly in tropical and subtropical regions where humidity and water exposure are significant risk factors. The high incidence of ear pain and discharge in our study population underscores the need for prompt diagnosis and treatment to prevent complications such as chronic otitis externa and necrotizing otitis externa. ^[10]

Benign neoplasms of the external ear, though less common, are an important consideration in the differential diagnosis of ear masses. Sebaceous cysts and chondromas were the most frequently observed benign neoplasms in our study, consistent with findings from other studies. These lesions are typically asymptomatic but may cause cosmetic concerns or discomfort if they become infected or enlarge. ^[11]

Malignant neoplasms of the external ear, though rare, are associated with significant morbidity and mortality. Squamous cell carcinoma was the most common malignant neoplasm in our study, accounting for 71.4% of malignant cases. ^[12] This finding is consistent with previous reports that have identified squamous cell carcinoma as the predominant type of external ear malignancy. Early detection and histopathological confirmation are crucial for effective management, as delayed diagnosis can result in advanced disease and poor outcomes. ^[14]

The role of histopathological evaluation in the diagnosis of external ear diseases cannot be overstated. ^[15] In our study, histopathological examination provided definitive diagnoses in all cases, guiding appropriate treatment and improving patient outcomes. The use of advanced diagnostic techniques, such as immunohistochemistry and molecular studies, may further enhance the accuracy of histopathological diagnosis and provide insights into the pathogenesis of these conditions. ^[16]

This study provides a comprehensive clinicopathological evaluation of external ear diseases in a tertiary care setting. The findings underscore the importance of early diagnosis and histopathological evaluation in the management of these conditions. Otitis externa was the most common diagnosis, while squamous cell carcinoma was the predominant malignant neoplasm. Further research is needed to explore the molecular mechanisms underlying these diseases and to develop targeted therapies for improved patient outcomes.

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3. Hobson CE, Moy JD, Byers RM, et al. Malignant neoplasms of the external ear. Laryngoscope. 2014;124(2):346-351.
4. Prasad S, Lee P, Lee JH, et al. Squamous cell carcinoma of the external ear: A review of 75 cases. Otolaryngol Head Neck Surg. 2015;152(5):878-882.
5. Lee DH, Kim YA, Park JH, et al. Clinicopathological analysis of malignant tumors of the external ear. Eur Arch Otorhinolaryngol. 2016;273(9):2537-2543.
6. Kim JY, Cho HH, Lee DH, et al. Benign tumors of the external ear: A clinicopathological analysis. J Laryngol Otol. 2017;131(5):431-435.
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11. Rubin Grandis J, Branstetter BF, Yu VL. The changing face of malignant (necrotising) otitis externa: Clinical, radiological, and anatomic correlations. Lancet Infect Dis. 2004;4(1):34-39.
12. Osguthorpe JD, Nielsen DR. Otitis externa: Review and clinical update. Am Fam Physician. 2006;74(9):1510-1516.
13. Hobson CE, Moy JD, Byers RM, et al. Malignant neoplasms of the external ear. Laryngoscope. 2014;124(2):346-351.
14. Prasad S, Lee P, Lee JH, et al. Squamous cell carcinoma of the external ear: A review of 75 cases. Otolaryngol Head Neck Surg. 2015;152(5):878-882.
15. Lee DH, Kim YA, Park JH, et al. Clinicopathological analysis of malignant tumors of the external ear. Eur Arch Otorhinolaryngol. 2016;273(9):2537-2543.
16. Kim JY, Cho HH, Lee DH, et al. Benign tumors of the external ear: A clinicopathological analysis. J Laryngol Otol. 2017;131(5):431-435.