Sage Journals: Discover world-class research

Abstract

Objectives

Hemangioma is a common soft tissue tumor that can be categorized mainly into cavernous, capillary, and venous subtypes. It usually develops in the head and neck and rarely in the external auditory canal (EAC).

Methods

A systematic review of patients with capillary hemangioma of the EAC was performed. A computerized systematic search was conducted in PubMed, Scopus, and Web of Science to extract relevant studies for a qualitative review.

Results

A total of 38 patients were included in the systematic review, and half of them were men. Hearing loss was the most common presenting feature (n = 19; 50%), followed by aural fullness (n = 15; 39.4%). Cavernous hemangioma was the predominant type (n = 22, 57.8%). Endaural and transcanal surgical approaches were the most frequent, with ten (26.3%) and nine (23.6%) cases, respectively. Most of the patients (n = 31; 81.5%) had no recurrence.

Conclusions

Hemangioma of the EAC may not be uncommon as healthcare professionals may expect. Hearing loss, aural fullness, and tinnitus are possible symptoms, but many patients remain asymptomatic. Surgical excision is the main effective management option, and complete resolution is the most prevalent outcome. Computed tomography assists in the diagnosis, but histopathological examination after resection is mandatory for the definitive diagnosis.

Keywords

hemangioma external auditory canal systematic review

Introduction

Hemangioma is defined as a benign vascular tumor that frequently affects the head and neck region. Based on histopathological findings, hemangioma can be classified into capillary, venous, and cavernous subtypes. Capillary hemangioma is recognized from the tightly coordinated capillary-like canals, while venous and cavernous subtypes are composed of larger vascular spaces.¹ In addition, arteriovenous malformation is also considered to be a category of hemangioma.² Hemangioma may arise within the temporal bone, particularly in the geniculate ganglion and internal auditory meatus, and frequently arises in the temporal segment of the facial canal as well as in the hypotympanic area.³ Hemangioma affecting the external auditory canal (EAC), with or without eardrum involvement, is also rarely reported in the literature.⁴ Furthermore, it may be asymptomatic and incidentally diagnosed or suspected in patients with bloody otorrhea, hearing loss, and pulsatile tinnitus.⁵ It is important to identify the site and size of capillary hemangioma to obtain an appropriate management approach. Therefore, the aim of this study was to systematically review all patients diagnosed with capillary hemangioma of the EAC in the literature to provide approximate statistics and a better understanding of reported lesions, management plans, and outcomes.

Patients and Methods

This systematic review was performed according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA; Supplementary Appendix 1). Our protocol was prepared and registered in PROSPERO (ID number 251546).

Search Strategy and Study Selection

In May 2020, a systematic computerized literature search was performed in PubMed, Scopus, and Web of Science using the following search terms: “external auditory canal” OR “external acoustic meatus” OR “external auditory meatus” AND “hemangioma.” Potentially relevant references were also searched manually. All articles reporting hemangioma in, but not limited to, the EAC were included. Studies were excluded if (i) the lesion was not in the EAC; (ii) did not provide individual data; (iii) they were reviews, book chapters, or posters; (iv) the language was not English; and (v) the full-text was unavailable. Articles were collected in one library using Endnote and then exported to an Excel file after removing duplicated references. Among the remaining reports, two authors independently screened the articles for potential eligibility using titles and abstracts.

Data Extraction and Quality Assessment

A data extraction form was prepared to blindly extract the data on study characteristics (publication year, country, year of research, and study design), patient demographics (age and sex), presenting symptoms, audiometric findings, radiological findings, lesion pathological type, surgical treatment approach, and follow-up results. Discrepancies were settled through a discussion among the authors. All included studies were assessed by at least two independent reviewers using the CARE checklist for case reports to evaluate the possible risk of bias. The reviewers then aAgreed on a quality rating among “good,” “fair,” and “poor,” as suggested by the guidelines.

Statistical Analyses

Simple descriptive statistics were performed to report variables; the mean, standard deviations, and frequencies were calculated using Microsoft Excel.

Results

Literature Search

A total of 172 articles were retrieved through a systematic search. After removing duplicates, only 130 reports remained for title/abstract screening. Of these, only 46 were potentially relevant. Finally, 35 case reports were eligible (Figure 1).

Figure 1.

Flow diagram of study selection and screening.

Basic Demographic Characteristics

The mean age of enrolled subjects (n = 38) was 46.6 ± 17.03 years. Men and women accounted for 50% of the reported population each. Hearing loss was the most common presenting feature (n = 19; 50%), followed by aural fullness (n = 15; 39.4%) and tinnitus (n = 10; 26.3%) (Figure 2). Individualized basic demographic data are presented in Table 1. Most studies were assessed with a good quality score (29 studies); however, five studies scored fair, and only one scored poor because of the lack of case report definitions in the title, keywords, or abstract; insufficient introduction; no adequate follow-up duration; or no mention of the informed consent obtained from the patient (Table 1). A detailed assessment of each domain of the CARE quality assessment tool is provided in Supplementary Appendix 2.

Figure 2.

Bar chart of reported presenting symptoms in enrolled cases.

Table 1.

Individualized Basic Demographic Data of Included Cases.

Author/Year	Age (ys)	Sex	Presenting Symptoms	QA Score
Chen CC/2020²	12	M	Hearing loss	Fair
Jeong J/2019⁶	62	F	Aural fullness	Fair
Kim CH/2019⁷	55	F	Hearing loss and otorrhagia	Good
Hussain JA/2018⁸	29	F	Itching	Good
Kim SB/2017⁹	54	F	Aural fullness	Good
David Crawford Dick/2016¹⁰	29	F	Aural fullness, hearing loss, otalgia, otorrhagia, and otorrhea	Good
Odat H/2016¹¹	45	F	Hearing loss, pulsatile tinnitus, and aural fullness	Good
Varshney S/2015¹²	23	M	Aural fullness, mild otalgia, and hearing loss	Good
Giuseppe Magliulo/2014¹³	43	M	EAC mass	Good
Feng HM/2013⁴	50	F	Autophony	Good
Feng HM/2013⁴	88	M	Referral for vascular lesion in EAC	Good
Soni RS/2013¹⁴	15	M	Bilateral hearing loss and aural fullness	Good
Spielmann PM/2013¹⁵	34	M	Aural fullness and tinnitus	Good
Cetinkaya Z/2013¹⁶	47	M	Hearing loss	Good
Shu MT/2013¹⁷	57	F	Otalgia	Poor
Vlaski L/2012¹⁸	38	F	Admission for atheroma excision	Good
Vlaski L/2012¹⁸	68	F	Otorrhagia, otorrhagia, hearing loss, and occasional headaches	Good
F Martines/2012¹⁹	59	M	Hearing loss, pulsatile tinnitus, intermittent aural fullness, otalgia, and otorrhagia	Good
Mevio E/2012²⁰	55	M	Otalgia, hearing loss, and pulsatile omolateral tinnitus	Good
Chul Ho Jang/2011²¹	49	M	Pulsatile tinnitus	Good
Wu F/2010²²	36	F	Hearing loss, aural fullness, and otorrhea	Good
Kimberley D Rutherford/2010⁵	62	F	Otorrhagia and aural fullness	Good
R Bovo/2010³	54	M	Nonpulsatile tinnitus, hearing loss, aural fullness, and mass	Good
Yasar H/2009²³	32	F	Otorrhagia	Good
Covelli E/2008²⁴	45	F	Hearing loss and aural fullness	Good
Pavamani SP/2007²⁵	26	F	Otorrhagia	Good
Sari M/2007²⁶	30	F	Hearing loss, itching, aural fullness, and nonpulsatile tinnitus	Good
D.J. Verret/2007²⁷	31	M	Hearing loss and the aural fullness	Good
Giuseppe Magliulo/2007²⁸	63	M	Pulsatile tinnitus	Good
Tsung-Han Yang/2005²⁹	72	F	EAC mass	Fair
Harukazu Hiraumi/2005³⁰	51	M	Hearing loss, otalgia, and otorrhea	Good
Reeck JB/2002³¹	53	M	Hearing loss and nonpulsatile tinnitus	Good
JM Bumpous/2002³²	67	F	EAC mass, hearing loss, tinnitus, and aural fullness	Good
Joshi SV/2000³³	16	M	Otorrhea and EAC mass	Fair
C G Jackson/1990³⁴	60	F	Repeated otitis externa	Good
J L Kemink/1983³⁵	52	M	EAC mass	Good
Freedman SI/1972³⁶	52	M	EAC mass	Fair
Freedman SI/1972³⁶	57	M	Otalgia	Fair

Note: M: male; F: female; EAC: external auditory canal.

Patients’ characteristics, interventions, and outcomes

Hemangioma was detected on the right side in 20 cases and on the left side in 15 cases. Three reports had not mentioned the affected side.^14,15,34 Conductive hearing loss was observed in ten cases, while sensorineural hearing loss was present in only four cases. In 26 (68.4%) cases, hemangioma was present in the EAC only, while it involved both the EAC and tympanic membrane in 12 cases. Cavernous hemangioma was the predominant type (n = 22, 57.8%), followed by capillary hemangioma (n = 11, 28.9%). All cases were managed with surgical intervention, except one, which was managed with radiotherapy.²⁵ Endaural and transcanal surgical approaches were the most frequent, with ten (26.3%) and nine (23.6%) cases, respectively. Most of the patients (n = 31, 81.5%) had no recurrence. The patient who received radiotherapy had no change in mass size.²⁵ Detailed lesions’ characteristics, interventions, and outcomes are presented in Table 2.

Table 2.

Characteristics, Interventions, and Outcomes of Reported Lesions.

Author/Year	Side	Audiometric findings	CT findings	Lesion location	Pathological type	Treatment approach	Follow up period (month)	recurrence
Chen CC/2020²	Left		A 17.5 mm ×7.6 mm × 7 mm left EAC lesion, with a strong enhancement after contrast injection but without substantial vessel connection or bone erosion	EAC	Capillary	Endaural approach and tympanoplasty	-	No
Jeong J/2019⁶	Right		A .5 × .5 cm inferiorly based, soft-tissue density mass	EAC	Cavernous	Retroauricular approach	12	No
Kim CH/2019⁷	Right	CHL with an air-bone gap of 35 dB	A soft-tissue mass with mild enhancement without bony erosion or destruction in the right EAC	EAC	Venous	Transcanal approach	16	No
Hussain JA/2018⁸	Left			EAC	Epithelioid	Surgical excision	9	No
Kim SB/2017⁹	Right	Moderate CHL, with an air-bone gap of 45 dB	A 1-cm poorly enhancing soft-tissue density lesion in the EAC, adjacent to the TM. No ME involvement	EAC/TM	Capillary	Transcanal microscopic surgery	12	No
David Crawford Dick/2016¹⁰	Right			EAC	Lobular capillary	Surgical excision	16	No
Odat H/2016¹¹	Right	CHL with an average air-bone gap of 30 dB	A 1.2-cm soft-tissue mass involving medial portion of the EAC, the posterior part of the TM, and the ME cavity reaching the attic and laying over the second genu of the facial nerve without bone erosion	EAC/TM/ME/aditus	Cavernous	Tympanoplasty, mastoidectomy	12	No
Varshney S/2015¹²	Right	Moderate CHL with an average air-bone gap of 33 dB	Poorly enhancing soft-tissue mass involving the right EAC and ME. The ossicular chain was partially embedded in vascular tissue without bone erosion	EAC/TM/ME	Capillary	Postaural approach	3	No
Giuseppe Magliulo/2014¹³	Left			EAC	Lobular capillary	Surgical excision	6	No
Feng HM/2013⁴	Left	No significant hearing impairment	A 10 × 4 mm focal mass confined to the bone portion of the EAC	EAC	Cavernous	Endaural approach	24	No
Feng HM/2013⁴	Right			EAC	Cavernous	Endaural approach	12	No
Soni RS/2013¹⁴		Bilateral CHL, worse on the right side	Bilateral partial atresia of the EACs	EAC	Venous	-	18	No
Spielmann PM/2013¹⁵				EAC	Cavernous	Endaural approach	-	-
Cetinkaya Z/2013¹⁶	Right	CHL (20Y25 dB air-bone gap at 250Y4000 Hz)	A 2-cm mass in the EAC, with contrast enhancement	EAC	Capillary	Transcanal approach	12	No
Shu MT/2013¹⁷	Right		A 5-mm mass limited to the EAC only	EAC	Cavernous	Postauriclular approach	60	No
Vlaski L/2012¹⁸	Right	Hearing threshold was bilaterally normal	A 17-mm oval, voluminous lesion prominating into the EAC lumen, with strong post contrast relatively homogenous high attenuation	EAC	Cavernous	Transmeatal approach	5	No
Vlaski L/2012¹⁸	Right	Severe, impaired auditory thresholds at frequencies of .5–4 kHz, 45-55-70-65 dBnHL, respectively, and a 40- to 59-dB AB gap	Isodense area in the right EAC, with sings of chronic changes in the mastoid antrum, without bone erosion	EAC	Mixed cavernous and capillary	Retroauricular approach and myringoplasty	3	No
F Martines/2012¹⁹	Right	Right mild mixed hearing loss with an average air-bone gap of 35 dB	A 1.8-cm soft-tissue mass lateral to the TM without bone erosion or ME extension	EAC	Cavernous	Endoaural approach	-	-
Mevio E/2012²⁰	Left	Mixed hearing loss (20–30 dB air-bone gap at 250–1000 Hz)	A round 3-mm smooth mass external to the TM without bone erosion or ME extension	EAC	Cavernous	Transcanal excision approach	12	No
Chul Ho Jang/2011²¹	Right	High frequency mild SNHL at 3000-8000 Hz	A .8×.5 cm isolated soft-tissue mass just lateral to the TM without bone erosion or ME extension	EAC	Cavernous	Postauricular approach and tympanoplasty	12	No
Wu F/2010²²	Left	A 50-dB threshold of hearing loss with a 25-dB air-bone gap	A soft-tissue mass located deep in the EAC, adjacent to the TM, with no bone destruction	EAC/TM	Capillary	Surgical excision and mygrinoplasty	12	No
Kimberley D Rutherford/2010⁵	Left	Normal pure tone thresholds	Normal temporal bones and no bone dehiscence	EAC	Cavernous	Transcanal approach	5	No
R Bovo/2010³	Left	A mixed hearing loss	A 5-cm mass obliterates the outer ear canal, posteriorly extending to the subcutaneous space of the retroauricular region and medially extending through the tympanic membrane to the posterior part of the middle ear cleft. It was separated from the jugular bulb. The ossicular chain was partially embedded by the vascular tissue, and no signs of bone erosion in the middle ear, the outer ear canal, or the cortical bone of the mastoid were found	EAC	Cavernous	Retroauricular approach	36	No
Yasar H/2009²³	Right		A 0.6 x .8 cm diameter soft–tissue mass arising the right EAC and .5 cm away from TM.	EAC	Capillary	Transcanal approach	48	No
Covelli E/2008²⁴	Left	Mild-to-moderate CHL	A 1.5-cm soft-tissue mass lateral to TM, which filled the left EAC without ME involvement or bone erosion	EAC	Cavernous	Endaural approach	3	No
Pavamani SP/2007²⁵	Left			EAC/TM/ME	Lobular capillary	Radiotherapy	60	No change in size of the residual lesion
Sari M/2007²⁶	Right	A 10- to 40-dB air-bone gap and a moderate CHL.	A 2-cm soft-tissue mass lateral to TM without bone erosion or ME extension	EAC	Lobular capillary	Endomeatal approach	4	No
D.J. Verret/2007²⁷	Right	Mild CHL of the right ear	A 16-mm mass in the EAC. Limited bony erosion of the EAC, no involvement of the TM, temporal lobe or internal carotid artery by the tumor	EAC	Cavernous	Postauricular approach	-	No
Giuseppe Magliulo/2007²⁸	Right	Mixed hearing loss in the right ear (15–20 dB air-bone gap at 250–1000 Hz, SNHL at 4000 and 8000 Hz)	A 3-mm soft-tissue mass in the poster superior region of the medial EAC and on the corresponding portion of the TM without bone erosion or ME extension	EAC/TM/malleus	Cavernous	Endaural approach and tympanoplasty	12	No
Tsung-Han Yang/2005²⁹	Left	Mild-to-moderate bilateral SNHL	A small soft-tissue mass occupying the left EAC without involvement of the epitympanum and adjacent bony wall	EAC	Cavernous	Transcanal approach	3	No
Harukazu Hiraumi/2005³⁰	Right	Right CHL with an air-bone gap of 35 dB	A round tumor just lateral to the TM without ME extension	EAC, TM	Capillary	Transcanal resection	36	No
Reeck JB/2002³¹	Left	A 10- to 30-dB air-bone gap component superimposed on an underlying sloping, high frequency SNHL pattern	An isolated soft-tissue mass in the posterior–inferior aspect of the medial EAC	EAC	Cavernous	Endaural approach	4	No
JM Bumpous/2002³²	Left	Moderate-to-profound mixed hearing loss	A 1.5-cm nonenhancing mass lateral to the TM that filled the left EAC without ME extension	EAC	Cavernous	Endaural approach	-	-
Joshi SV/2000³³	Left			EAC/TM/bone	Cavernous	Mastoidectomy	-	-
C G Jackson/1990³⁴		A 50-dB gap SRT and 96% discrimination score		EAC/TM/bone	Mixed cavernous and capillary	Partial TB resection, STSG (split thickness skin graft.)	3	Yes
J L Kemink/1983³⁵	Right			EAC/TM	Cavernous	Tympanoplasty and mastoidectomy	-	-
Freedman SI/1972³⁶	Right			EAC/TM	Cavernous	Endaural approach	60	No
Freedman SI/1972³⁶	Left			EAC/TM	Cavernous	Transcanal excision	18	No

Blank cells have not been reported. Abbreviations: TM, tympanic membrane; ME, middle ear; EAC, external auditory canal; CHL, conductive hearing loss; Y, year; M, month; STSG, split-thickness skin graft; SNHL, sensorineural hearing loss.

Discussion

Hemangioma is a common soft tissue tumor that can be categorized into cavernous, capillary, and venous subtypes. To our knowledge, a total of 38 patients have been reported to have hemangioma of the EAC in the literature. Cavernous hemangioma accounted for more than half (57%) of the reported cases. Generally, cavernous hemangioma is most frequently reported in adults, while capillary hemangioma is most frequently reported in infants. This may be explained by the spontaneous regression of capillary lesions over time, as they develop in the dermis and more superficially than the cavernous type, which grows more deeply.⁴ Capillary lesions are usually confined to the EAC. Although this was the most common finding (68.4%), and this report focused on the database search of EAC hemangiomas, tympanic membrane involvement has been reported. Two patients have had bone involvement,^33,34 and one of them developed recurrence despite complete excision.³⁴ All reports were published from 1972 to 2020, with no sex predominance or specific and consistent presenting features. A study by Freedman et al³⁶ reported two men: one with otalgia, while the other with only a mass. Chen et al recently reported a boy presenting with hearing loss due to an EAC-localized capillary hemangioma.² As hemangioma is usually small, ranging from 5 mm to 3 cm, some patients may remain asymptomatic. A literature search yielded nine cases presenting with a mass only. A prompt diagnosis of capillary hemangioma of the EAC may be challenging, and the differential diagnosis includes carcinoma, glomus tumor, cholesteatoma, and arteriovenous malformation.⁷ The otoscopic examination usually shows a small sessile or pedunculated mass present in the anterior or posterior segments of the EAC. Our search showed that computed tomography was performed in 27 (71%) of 38 patients. Pure-tone audiometry, computed tomography of the temporal bone, and magnetic resonance imaging are of great value to assess the extent of the lesion, detect bony erosion, and direct the next step of surgical management.¹⁹ In addition, angiography may be helpful in identifying and embolizing the feeding blood vessels, particularly in large lesions with probable excessive bleeding.¹⁹ Nonetheless, histopathology after surgical removal is essential to confirm the diagnosis and rule out any other possible pathology. Although careful observation may be sufficient for delicate asymptomatic lesions, surgical excision is the mainstay effective approach, mostly with the endaural, transcanal, or retroauricular approach.^2,4,6-9 Our findings indicated that complete resolution with no recurrence is the most common outcome (81.5%), although recurrence was reported by Jackson et al.³⁴ Therefore, we recommend that surgeons perform further follow-ups. While the present study is the first to systematically review all cases of capillary hemangioma of the EAC, it has some limitations. First, we searched only three major databases. Second, we included only English articles, thereby possibly missing some relevant studies. Therefore, the results of the present study should be cautiously interpreted in clinical practice.

Conclusion

This short report revealed that hemangioma of the EAC may not be as uncommon as healthcare professionals may expect. The systematic search yielded 38 patients with a wide range of ages, and cavernous hemangioma was the most common type. Hearing loss, aural fullness, and tinnitus are possible presenting symptoms. Surgical excision is the most effective treatment modality, but postoperative follow-ups are recommended to avoid possible recurrence and bone erosion. Although computed tomography assists the diagnosis, histopathology following surgical resection is essential for the definitive diagnosis.

Supplemental Material

sj-pdf-1-afs-10.1177_01455613211042449 – Supplemental Material for What Makes a Military Professional? Evaluating Norm Socialization in West Point Cadets

Supplemental Material, sj-pdf-1-afs-10.1177_01455613211042449 for Clinical Approaches To External Auditory Canal Hemangiomas: A Systematic Review by Afrah Alshalan, Tawfiq Khurayzi, Majed Assiri, Abdulrahman Alsanosi and in Ear, Nose & Throat Journal

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Afrah Alshalan

Tawfiq Khurayzi

Majed Assiri

Supplemental Material

Supplemental material for this article is available online.

References

Hopfel-Kreiner

. Histogenesis of hemangiomas--an ultrastructural study on capillary and cavernous hemangiomas of the skin. Pathol Res Pract. 1980;170(1-3):70-90.

Chen

C-C

Chen

C-K

. Capillary hemangioma of the external auditory canal. Ear Nose Throat J. 2019;99(2):NP21-NP22.

Bovo

Ciorba

Castiglione

Martini

. Cavernous hemangioma of the external ear: case report and literature review. B-ENT. 2010;6(2):127-130.

Feng

Chen

Shi

Chang

Wang

. Cavernous hemangioma of the external auditory canal: Two case-reports and a literature review. J Int Adv Otol. 2013;9(1):126-130.

Rutherford

Leonard

. Hemangiomas of the external auditory canal. Am J Otolaryngol. 2010;31(5):384-386.

Jeong

Kim

Choi

. Cavernous hemangioma of the external auditory canal in patients older than 60 years: A rare tumor. Ear Nose Throat J. 2019;100:522S-524S.

Kim

C-H

Lee

Kim

S-Y

Shin

. Unusual tumors obstructing the external auditory canal: Report of two cases. J Audiol Otol. 2019;23(1):59-62.

Hussain

Al Zamel

Nawaz

. Angiolymphoid hyperplasia with eosinophilia (epithelioid hemangioma) of the external auditory canal, an unusual presentation in an adult female: a case report. J Surg Case Rep. 2018;2018(7):rjy145.

Kim

Lee

H-H

. Capillary hemangioma of the tympanic membrane and external auditory canal. J Craniofac Surg. 2017;28(3):e231-e232.

10.

Dick

Elliott

Napier

Adair

. Pregnancy tumour of the external auditory canal: treatment in clinic. BMJ Case Rep. 2016;2016:bcr2015213673.

11.

Odat

Al-Qudah

. Cavernous hemangioma of the external canal, tympanic membrane, and middle ear cleft: a case report. Head Neck Pathol. 2016;10(2):261-264.

12.

Varshney

Malhotra

Kaur

Gairola

. Capillary haemangioma: a rare vascular tumour of the external auditory canal. Indian J Otolaryngol Head Neck Surg. 2015;67(4):417-421.

13.

Magliulo

Iannella

Gianno

. Lobular capillary hemangioma and external auditory canal. Otol Neurol. 2014;35:213-214.

14.

Soni

Mirani

Jyung

. Hemangioma of the external auditory canal in an adolescent male: report of a case and review of the literature. Int J Pediatr Otorhinolaryngol. 2013;8(3):66-68.

15.

Spielmann

McKean

White

Hussain

SSM

. Surgical management of external auditory canal lesions. J Laryngol Otol. 2013;127(3):246-251.

16.

Cetinkaya

Toplu

Kizilay

Aydin

. Acquired capillary hemangioma with features of tufted angioma in the external auditory canal. J Craniofac Surg. 2013;24(3):e270-e271.

17.

Shu

M-T

K-C

Chen

Y-C

. Cavernous hemangioma of the external auditory canal. Ear Nose Throat J. 2013;92(5):168.

18.

Vlaski

Dankuc

Vuckovic

Kljajic

Dragicevic

Lemajic-Komazec

. Hemangiomas of the external auditory canal: A literature review and two new case reports. Cent Eur J Med. 2012;7(3):344-348.

19.

Martines

Bentivegna

Maira

Marasà

Ferrara

. Cavernous haemangioma of the external auditory canal: clinical case and review of the literature. Acta Otorhinolaryngol Ital :. 2012;32(1):54-57.

20.

Mevio

Cazzaniga

Mullace

Paolotti

. Hemangioma of the tympanic membrane: a case and a review of the literature. Case Rep Otolaryngol. 2012;2012:402630.

21.

Jang

Choi

Hong

Cho

. Cavernous hemangioma of the tympanic membrane. Clin Exp Otorhinolaryngol. 2011;4(2):109.

22.

Chan

. A capillary hemangioma with external auditory canal and tympanic membrane involvement. J Int Adv Otol. 2010;6(2):291-294.

23.

Yasar

Ozkul

Somay

. A rare vascular tumor of the external auditory canal: the capillary hemangioma. J ear, nose, throat. 2009;19(4):212-215.

24.

Covelli

De Seta

Zardo

De Seta

Filipo

. Cavernous haemangioma of external ear canal. J Laryngol Otol. 2008;122(8):e19.

25.

Pavamani

Surendrababu

Ram

Thomas

Viswanathan

. Capillary haemangioma involving the middle and external ear: radiotherapy as a treatment method. Australas Radiol. 2007;51(4):394-397.

26.

Sari

Baylancicek

Eren

Tutkun

. Lobular capillary hemangioma of the external auditory canal. Mediterranean Journal of Otology. 2007;3(1):58-61.

27.

Verret

Spencer Cochran

Defatta

Samy

. External auditory canal hemangioma: case report. Skull Base. 2007;17(2):141-143.

28.

Magliulo

Parrotto

Sardella

Rocca

Cd.

. Cavernous hemangioma of the tympanic membrane and external ear canal. Am J Otolaryngol. 2007;28(3):180-183.

29.

Yang

T-H

Chiang

Y-C

Chao

P-Z

Lee

F-P

. Cavernous hemangioma of the bony external auditory canal. Otolaryngology-Head Neck Surg (Tokyo). 2006;134(5):890-891.

30.

Hiraumi

Miura

Hirose

. Capillary hemangioma of the tympanic membrane. Am J Otolaryngol. 2005;26(5):351-352.

31.

Reeck

Yen

Szmit

Cheung

. Cavernous hemangioma of the external ear canal. Laryngoscope. 2002;112(10):1750-1752.

32.

Bumpous

Limb

Mabrie

Carey

Minor

. Hemangioma of the external auditory canal. Otolaryngology-Head Neck Surg (Tokyo). 2002;126(1):74-75.

33.

Joshi

Wakode

. A rare case of haemangioma of the tympanic membrane and external auditory canal. Indian J Otolaryngol Head Neck Surg. 2000;52(2):171.

34.

Jackson

Levine

McKennan

. Recurrent hemangioma of the external auditory canal. Am J Otol. 1990;11(2):117-118.

35.

Kemink

Graham

McClatchey

. Hemangioma of the external auditory canal. Am J Otol. 1983;5(2):125-126.

36.

Freedman

Barton

Goodhill

. Cavernous angiomas of the tympanic membrane. Arch Otolaryngol Head Neck Surg. 1972;96(2):158-160.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.35 MB

0.27 MB