Indian Journal of Otology

ORIGINAL ARTICLE
Year
: 2018  |  Volume : 24  |  Issue : 1  |  Page : 20--22

A novel modality of treatment for pseudocyst of auricle


Yogesh Dabholkar, Shreyas Chawathey, Haritosh Velankar 
 Department of ENT, D. Y. Patil University School of Medicine, Mumbai, Maharashtra, India

Correspondence Address:
Prof. Yogesh Dabholkar
B-306, Plot No. 31, Sector 42 A, Nerul, Navi Mumbai - 400 706, Maharashtra
India

Abstract

Introduction: Pseudocyst of auricle is benign painless idiopathic cystic swelling on anterior surface of auricular cartilage with no definitive treatment and with a tendency to recur. We describe a novel modality of treatment for this condition. Methods: 14 patients treated by aspiration followed by pressure dressing with a silicone-based impression material used for hearing aid fitting. These patients were followed up over a six month period. Results: 13 patients had a successful outcome with complete resolution of swelling and without any recurrence. Only 1 patient (7.14%) showed recurrence after 2 weeks of treatment due to ineffective compression which was subsequently managed successfully by the same procedure. Conclusion: Complete aspiration and compression dressing using a silicone-based material (used to make hearing aid moulds) in our experience is a safe, inexpensive, non-invasive and effective method for management of the pseudocyst of the auricle.



How to cite this article:
Dabholkar Y, Chawathey S, Velankar H. A novel modality of treatment for pseudocyst of auricle.Indian J Otol 2018;24:20-22


How to cite this URL:
Dabholkar Y, Chawathey S, Velankar H. A novel modality of treatment for pseudocyst of auricle. Indian J Otol [serial online] 2018 [cited 2021 Oct 25 ];24:20-22
Available from: https://www.indianjotol.org/text.asp?2018/24/1/20/233119


Full Text



 Introduction



Pseudocyst of the auricle is a benign, idiopathic, and painless, dome-shaped cystic swelling on the anterior surface of the auricle with no known predisposing factors and commonly arises from cymba conchae, scaphoid fossa, and triangular fossa of the auricle.[1],[2] These lesions are also called as endochondral pseudocyst, intracartilaginous cyst, and benign idiopathic cystic chondromalacia.[3]

Histologically, it is an intracartilaginous cyst with no epithelial lining (hence named pseudocyst). It contains straw- or yellow-colored, viscous, albuminous fluid which has osmolarity, glucose, and protein concentrations similar to those of plasma.[4]

It is a challenging disorder to manage with medical or surgical means. Hence, a large body of evidence describing different modalities of management has emerged in the literature. Definitive treatment still remains elusive. Goals of treatment include preservation or restoration of the normal architecture of the auricle and prevention of recurrence.[4]

We present our experience of management of this less common condition of the auricle in a cohort of 14 patients treated by aspiration followed by pressure dressing with a silicone-based impression material used for hearing aid fitting.

 Materials and Methods



Fourteen patients with diagnosis of pseudocyst of pinna from May 2015 to July 2017 were included in this study which was approved by our Institutional Ethics Committee. Informed consent was obtained from all patients for enrollment in the study.

A diagnosis of pseudocyst was made based on aspiration of straw-colored fluid [Figure 1]. All 14 patients underwent complete aspiration of the pseudocyst using strict aseptic precautions with a thick-bored needle (18G) along with compression dressing for 2 weeks using a silicone-based material used for making hearing aid molds [Figure 2].{Figure 1}{Figure 2}

The compression dressing was removed after 2 weeks and pinna inspected for any swelling [Figure 3]. The patients were reviewed for any recurrence of swelling every month for 6 months.{Figure 3}

 Results



Fourteen patients were diagnosed to have pseudocyst of the pinna from May 2015 to July 2017. The age distribution in our study ranged from 20 years to 40 years. Male preponderance of 92.86% was seen. Right-sided lesions (57.15%) were more common than the left (42.85%). The lesion was seen more in the scaphoid fossa (57.15%) followed by the triangular fossa (28.57%) and cymba concha (14.28%).

Thirteen patients had complete resolution of the swelling without any signs of recurrence even at 6-month follow-up. Only one patient (7.14%) had recurrence after 15-day postprocedure which may be due to ineffective pressure produced by the compression dressing. The procedure was repeated and the patient had no recurrence on follow-up.

 Discussion



Pseudocyst of the pinna is a rare condition occurring commonly in young adults predominantly in males. Common sites of predilection of this condition include scaphoid fossa, followed by triangular fossa and cymba concha.

The etiology of this condition is unknown. Several hypotheses have been propounded to explain its pathogenesis. A hormonal influence altering the inflammatory process has been put forth to explain its male preponderance.[5] Engel hypothesized that abnormal release of lysosomal enzymes from local chondrocytes gives rise to progressive dilation and formation of an intracartilaginous cavity.[1] One of the theories proposed furthers congenital embryonic dysplasia of the auricular cartilage with reopening of residual tissue planes to give rise to the pseudocyst.[6] Engel hypothesized that abnormal release of lysosomal enzymes from local chondrocytes gives rise to progressive dilation and formation of an intracartilaginous cavity.[7]

There is currently no gold standard treatment. Various treatment modalities for management include simple aspiration, intralesional corticosteroids and aspiration in combination with bolstered pressure sutures, invasive techniques such as incision and drainage followed by its obliteration by curettage, and inserting a small drainage tube into the cavity with a guide wire.[7],[8],[9],[10],[11],[12] Sclerosing agents such as minocycline and open deroofing have also been recommended.[13],[14] Recently, fibrin glue as a sealing medium between the two cartilaginous flaps as a modality of treatment has been reported.[15] Most of the treatment modalities have resulted in significant rates of recurrence as seen in one study where significant number of patients had recurrence following aspirations and incision and drainage of pseudocyst of the pinna.[16]

We managed 14 patients with auricular pseudocyst between May 2015 to July 2017 who came to our Otorhinolaryngology Department which is in a tertiary care teaching and research hospital. All the patients were treated with complete aspiration of the cyst with an 18G needle and compression patch of a silicone-based material, used for making hearing aid molds, for 2 weeks. All the patients were followed up for about 6 months. Only one patient (7.14%) showed recurrence after 2 weeks of treatment due to ineffective compression. We managed this patient again with similar compression dressing. This patient had no recurrence after retreatment. Thus, effective compression dressing is of significance in terms of outcomes in the management of an auricular pseudocyst. We found this method to be effective in our setup for management of this condition whose gold standard treatment is still under speculation.

 Conclusion



Complete aspiration and compression dressing using a silicone-based material (used to make hearing aid molds) in our experience is a safe, inexpensive, noninvasive, and effective method for management of the pseudocyst of the auricle and has been effective in 13 (92.86%) cases in our study with only 1 case (7.14%) recurrence on initial treatment. It is also a cost-effective and simpler method which gives acceptable cosmetic results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Engel D. Pseudocysts of the auricle in Chinese. Arch Otolaryngol 1966;83:197-202.
2Choi S, Lam KH, Chan KW, Ghadially FN, Ng AS. Endochondral pseudocyst of the auricle in Chinese. Arch Otolaryngol 1984;110:792-6.
3Chen Q, Fei Y, Zhao T, Luo D, Wu B, Yang X, et al. Research on the immunological cause of auricular pseudocyst. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2001;15:304-5.
4Schulte KW, Neumann NJ, Ruzicka T. Surgical pearl: The close-fitting ear cover cast – a noninvasive treatment for pseudocyst of the ear. J Am Acad Dermatol 2001;44:285-6.
5Bhat VS, Shilpa, Nitha, Ks R. Deroofing of auricular pseudocyst: Our experience. J Clin Diagn Res 2014;8:KC05-7.
6Lee JA, Panarese A. Endochondral pseudocyst of the auricle. J Clin Pathol 1994;47:961-3.
7Miyamoto H, Okajima M, Takahashi I. Lactate dehydrogenase isozymes in and intralesional steroid injection therapy for pseudocyst of the auricle. Int J Dermatol 2001;40:380-4.
8Lim CM, Goh YH, Chao SS, Lynne L. Pseudocyst of the auricle. Laryngoscope 2002;112:2033-6.
9Chang CH, Kuo WR, Lin CH, Wang LF, Ho KY, Tsai KB, et al. Deroofing surgical treatment for pseudocyst of the auricle. J Otolaryngol 2004;33:177-80.
10Hegde R, Bhargava S, Bhargava KB. Pseudocyst of the auricle: A new method of treatment. J Laryngol Otol 1996;110:767-9.
11Ophir D, Marshak G. Needle aspiration and pressure sutures for auricular pseudocyst. Plast Reconstr Surg 1991;87:783-4.
12Zhu LX, Wang XY. New technique for treating pseudocyst of the auricle. J Laryngol Otol 1990;104:31-2.
13Oyama N, Satoh M, Iwatsuki K, Kaneko F. Treatment of recurrent auricle pseudocyst with intralesional injection of minocycline: A report of two cases. J Am Acad Dermatol 2001;45:554-6.
14Harder MK, Zachary CB. Pseudocyst of the ear. Surgical treatment. J Dermatol Surg Oncol 1993;19:585-8.
15Tuncer S, Basterzi Y, Yavuzer R. Recurrent auricular pseudocyst: A new treatment recommendation with curettage and fibrin glue. Dermatol Surg 2003;29:1080-3.
16Rehman A, Sangoo M, Hamid S, Wani A, Khan N. Recurrent pseudocyst pinna: A rational approach to treatment. Int J Sci Res Publ 2013;3:1-4.