Pseudocyst of the Auricle

Introduction:

A cyst-like formation due to the accumulation of fluid in the unlined cartilaginous cavity in the ear is called a pseudocyst of the auricle. This cyst occurs in the anthelix of the ear. More common in males. It is a benign condition occurring in the lateral or anterior part of the ear. The cystic lesion is typically one to five centimeters in size and is located in the scaphoid or triangular fossa.

What Is a Pseudocyst of the Auricle?

A cystic lesion in the side or front region of the ear that is benign is known as a pseudocyst of the auricle. It was first reported in the year 1846 by Hartmann. It was described in English by Engel in 1966. It has many names, like endochondral pseudocyst, intra cartilaginous cyst, cystic chondromalacia, auricular seroma, and benign idiopathic cystic chondromalacia. It is an uncommon condition, hence is misdiagnosed or undiagnosed. It may occur at the age of 30 to 39 years but rarely may be seen among children and old age also.

Lesions appear soft and become hard as time passes. They are filled with viscous fluid of straw-colored that looks similar to olive oil, and it is serous fluid. Lesions appear on one side, but they may also be seen on both ears. The right ear is the most commonly affected ear.

What Are the Causes of the Pseudocyst of the Auricle?

The cause of the pseudocyst of the auricle is not known. Different theories suggest that it may be caused due to

• Trauma that is chronic and of low grade. It was believed that trauma caused pseudocysts. Many had a history of trauma before the formation of the pseudocyst of the ear. Many others had chronic pressure or friction, such as wearing a tight helmet or sleeping on a hard pillow. One of the studies observed that pressure and friction caused ischemia and cartilaginous degeneration.

• The cartilage of the ear may have a defect during birth.

• Inflammatory cells and granulation tissues may be responsible for the separation of intra-cartilaginous spaces.

• Increased interleukin-6 may stimulate chondrocyte proliferation.

• Neurological diseases like ataxia may cause trauma that may lead to auricular cysts.

Lesions arise spontaneously among many individuals. It is believed that the pseudocyst is formed as a defect during embryogenesis. It is formed from the residual plane of tissues during the folding of branchial outgrowths to form an auricle. These excess tissues reopen when subjected to mechanical stress resulting in the development of a pseudocyst of the auricle.

What Are the Symptoms of the Pseudocyst of the Auricle?

Pseudocyst is asymptomatic in nature but occasionally shows mild pain or discomfort. Fluctuent outer ear swelling and inflammation may be observed.

How to Diagnose the Pseudocyst of the Auricle?

Diagnosis of the pseudocyst can be made by

• Taking a medical history and doing a clinical examination of an individual.

• The histologic evaluation shows that histopathologic characteristics include granulation tissue, fibrous tissue, cartilaginous tissue lining with no epithelium, and hyalinizing degeneration of the surrounding cartilage. Perivascular mononuclear infiltrate and lymphocytes are more commonly seen.

What Is the Treatment for the Pseudocyst of the Auricle?

Various chemical and surgical methods are used to treat the pseudocyst of the ear. Treatment of the pseudocyst of the auricle is as follows:

1) Therapeutic management includes-

• Alteration of the exposed cartilage surfaces.

• Adequate compression of the separated cartilage without allowing the fluid to accumulate.

2) Other methods of treatment are -

• Conservative management - Aspiration and pressure dressing along with or without intralesional or oral corticosteroids given. Recent studies have shown that intralesional and corticosteroids are not to be used as the first line of treatments as they may cause the deformity of the pseudocysts.

• Surgical - Curettage with fibrin sealant. This can be improved by using one percent iodine tincture and another sclerosant, like 50 % trichloroacetic acid, into the cavity of the pseudocyst.

• Deroofing of the cyst and buttoning. This helps in maintaining localized pressure and help in reducing the risk of recurrence, and also reducing the risk of necrosis of the skin on the cartilage.

• By doing a punch biopsy and applying bolsters.

• By using a guide needle, insert a drainage tube into the pseudocyst.

• Removing a piece of cartilage from behind the lesion and then a drain is placed to remove the fluid.

Many of these methods may damage the cartilage and change its normal anatomy. This also may not be acceptable cosmetically, and they have a tendency to recur.

Very few are discovered untreated. A basic dental wax can be shaped to the form of the ear and inserted in the area where the fluid was collected after draining it. It is wrapped in an elastocrape bandage. An individual had no scarring or recurrence after 4 months. If necessary, this technique can be added following aspiration and intralesional steroids. If an individual is not concerned about the cosmetic appearance, then observation of the lesion is the alternative to the treatment of the lesion.

What Is the Differential Diagnosis of the Pseudocyst of the Auricle?

Differential diagnosis includes

• Cauliflower Ear- Untreated pseudocyst of the auricle or subperichondrial hematoma results in a permanent deformity of the ear.

• Relapsing Polychondritis- The ear appears pink and red except for the lobe, which is devoid of cartilage.

• Chondrodermatitis Nodularis Helicis- Small, erythematous, painful nodules or nodules are crusted at the center of the lesion.

• Keloid- These are seen on the ear, especially on the ear lobe, among those who have pierced their ears.

• Subperichondrial Hematoma- These occur secondary to trauma.

• Cellulitis- It is a serious bacterial skin infection where the skin is swollen and inflamed.

Other than these, many lesions are similar to the pseudocyst of the auricle. They are angiosarcoma, dermal cyst, fibroma, epidermal inclusion cyst, rheumatoid nodule, tophus, xanthoma, etc.

Conclusion:

A pseudocyst of the auricle is a rare condition of the ear. The ear is an important organ of the body. Any slight changes in the ear may lead to discomfort and affect the quality of life of an individual. These may appear spontaneously, and they are asymptomatic and noninflammatory. Hence it becomes important to know about the condition, its cause, symptoms, diagnosis, and treatments. Knowing about the condition helps in seeking the help of a healthcare provider early. Early diagnosis leads to effective treatment. This, in turn, helps in achieving a good quality of life.