Kevin C. Pons, MA, FAAA
Yankton Medical Clinic; Yankton, SD

This 83 year old male nursing home patient was referred to the Yankton Medical Center ENT Department by the Urology Department where he was under treatment for prostate cancer. The patient reported a history of bilateral hearing loss greater on AS and a lump visible at the aperture of his left ear canal. Uncertain as to the specific duration of his otic/audiologic symptoms, the patient estimated that they had been present for more than a decade. He had been treated throughout the years with a variety of antibiotics for non-ear related infections, none of which effected a change in auditory acuity.

Physical exam showed a large, non-occlusive growth on the medial surface of the tragus extending anteriorly and medially towards the canal orifice. The mass could be elevated from the tragus revealing its smaller diameter stalk-like attachment.


Pure tone audiometry revealed a moderate low frequency HL AD which sloped to a severe loss level in the higher frequencies. There was no air/bone gap. AS revealed a profound mixed loss with large air/bone gaps from 250-1KHz. Tympanograms were Type A AD, Type B AS. Word recognition was poor AD at MCL, very poor AS at the limits of the audiometer. Since the middle ear effusion had been present for many years and was unresponsive to conservative measures, a myringotomy was performed. A copious amount of serous fluid was suctioned from the middle ear. (Pre- and post operative audiograms are shown below.

The fibroma was then surgically excised. The mass measured 14 mm long, 11mm high, and 8 mm wide. The pathology report interpreted the specimen as an intradermal nevus. There appeared to be prominent focal pigmentation and fibrosis as well as small epidermal inclusion cysts. Some of the changes in the specimen were felt to be secondary to chronic irritation-trauma.

The patient was also concerned about his inability to hear the staff at the nursing home where he resided. The patient noted hearing improvement following the myringotomy but continued difficulty persisted. Consequently, after review of the benefits and limitations of amplification, an ear impression was made of the right ear using a low viscosity silicone which was sent to a hearing aid manufacturer to fabricate a full concha, no helix, moderate canal length ITE with HDP2 circuitry. An extraction filament was added to aid removal. Binaural amplification will be considered following complete healing of the surgical site.