Fibrous Dysplasia of the Temporal Bone Presenting with Chronic Suppurative Otitis Media: Not All Chronic Ear Discharge is CSOM Article Swipe
Dear Editor, We read with interest the grand rounds presentation of Alvarez and Uy describing a patient with fibrous dysplasia (FD) of the temporal bone.1 While the authors provide valuable insights into a rare presentation, we wish to highlight significant concerns regarding the diagnostic framework used in this case. Chronic suppurative otitis media (CSOM) is described as a chronic inflammation of the middle ear and mastoid that presents with recurrent ear discharge or otorrhea through a tympanic membrane perforation. The disease usually begins in childhood as a spontaneous tympanic perforation due to an acute infection of the middle ear, known as acute otitis media (AOM), or as a sequelae of less severe forms of otitis media.2 It is clear that the infection begins in the middle ear, and is associated with a perforation of the tympanic membrane. One cannot diagnose CSOM in the absence of evidence of a tympanic membrane perforation. In the case presented in the article, we note that the diagnosis of chronic suppurative otitis media was first made simply based on the presence of a 1-year history of clear, non-foul-smelling discharge from his left ear associated with intermittent otalgia. This suggests that the physician evaluating the patient thinks that all patients presenting with a long history of otorrhea and otalgia have CSOM. That is an obvious fallacy, as conditions such as (but not limited to) chronic otitis externa, temporal bone carcinoma, a long-standing foreign body in the ear canal, and external canal cholesteatoma can also present with the exact same symptoms. We would like to point this out as a demonstration of the availability bias or availability heuristic. This diagnosis led to the patient being treated for 3 months with management specific to CSOM. It is only later that we learn that there is a hard mass in the external auditory canal. This apparently blocks the external auditory canal, as there is no mention whatsoever of the status of the tympanic membrane. The CT scan, done after the patient did not respond to their medical therapy, shows the presence of a bony lesion whose description ("ground glass") indicates a fibro-osseous lesion such as fibrous dysplasia. It must be noted that this lesion obliterates the external auditory canal and middle ear. The medical literature on fibrous dysplasia of the temporal bone describes a sequelae that can explain the patient’s symptoms without resorting to a diagnosis of CSOM. Fandino et al.3 state: Fibrous dysplasia involving the temporal bone is an unusual presentation, with the most common associated finding being conductive hearing loss and stenosis of the external auditory canal (EAC), seen in approximately 8% of patients. Stenosis of the ear canal can result in secondary canal cholesteatoma with extension into the middle ear, leading to conductive hearing loss because of either canal obstruction or erosion/fixation of the ossicular chain.
Related Topics
Concepts
Medicine
Chronic Suppurative Otitis Media
Temporal bone
Middle ear
Tympanic Membrane Perforation
Cholesteatoma
Perforation
Otitis
Ear canal
Dysplasia
Surgery
Mastoidectomy
Physical examination
Tympanic cavity
Eustachian tube
Medical history
Presentation (obstetrics)
Fibrous dysplasia
Chronic disease
Dermatology
Hearing loss
Disease
Differential diagnosis
Metadata
- Type
- article
- Landing Page
- https://doi.org/10.32412/pjohns.v40i2.2731
- https://pjohns.pso-hns.org/index.php/pjohns/article/download/2731/2599
- OA Status
- diamond
- OpenAlex ID
- https://openalex.org/W7104449435
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W7104449435Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.32412/pjohns.v40i2.2731Digital Object Identifier
- Title
-
Fibrous Dysplasia of the Temporal Bone Presenting with Chronic Suppurative Otitis Media: Not All Chronic Ear Discharge is CSOMWork title
- Type
-
articleOpenAlex work type
- Publication year
-
2025Year of publication
- Publication date
-
2025-11-07Full publication date if available
- Authors
-
Nathaniel YangList of authors in order
- Landing page
-
https://doi.org/10.32412/pjohns.v40i2.2731Publisher landing page
- PDF URL
-
https://pjohns.pso-hns.org/index.php/pjohns/article/download/2731/2599Direct link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
diamondOpen access status per OpenAlex
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https://pjohns.pso-hns.org/index.php/pjohns/article/download/2731/2599Direct OA link when available
- Concepts
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Medicine, Chronic Suppurative Otitis Media, Temporal bone, Middle ear, Tympanic Membrane Perforation, Cholesteatoma, Perforation, Otitis, Ear canal, Dysplasia, Surgery, Mastoidectomy, Physical examination, Tympanic cavity, Eustachian tube, Medical history, Presentation (obstetrics), Fibrous dysplasia, Chronic disease, Dermatology, Hearing loss, Disease, Differential diagnosisTop concepts (fields/topics) attached by OpenAlex
- Cited by
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0Total citation count in OpenAlex
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| abstract_inverted_index.into | 31, 450 |
| abstract_inverted_index.left | 186 |
| abstract_inverted_index.less | 110 |
| abstract_inverted_index.like | 256 |
| abstract_inverted_index.long | 207 |
| abstract_inverted_index.loss | 422, 458 |
| abstract_inverted_index.made | 170 |
| abstract_inverted_index.mass | 299 |
| abstract_inverted_index.most | 415 |
| abstract_inverted_index.must | 359 |
| abstract_inverted_index.note | 159 |
| abstract_inverted_index.only | 289 |
| abstract_inverted_index.rare | 33 |
| abstract_inverted_index.read | 3 |
| abstract_inverted_index.same | 252 |
| abstract_inverted_index.seen | 431 |
| abstract_inverted_index.such | 222, 354 |
| abstract_inverted_index.that | 66, 119, 160, 194, 201, 291, 294, 362, 386 |
| abstract_inverted_index.this | 47, 259, 363 |
| abstract_inverted_index.used | 45 |
| abstract_inverted_index.wish | 36 |
| abstract_inverted_index.with | 4, 17, 68, 130, 189, 205, 249, 282, 413, 448 |
| abstract_inverted_index.CSOM. | 214, 286, 398 |
| abstract_inverted_index.While | 25 |
| abstract_inverted_index.acute | 93, 101 |
| abstract_inverted_index.after | 329 |
| abstract_inverted_index.based | 172 |
| abstract_inverted_index.being | 277, 419 |
| abstract_inverted_index.canal | 244, 369, 429, 441, 446, 462 |
| abstract_inverted_index.case. | 48 |
| abstract_inverted_index.clear | 118 |
| abstract_inverted_index.exact | 251 |
| abstract_inverted_index.first | 169 |
| abstract_inverted_index.forms | 112 |
| abstract_inverted_index.grand | 7 |
| abstract_inverted_index.known | 99 |
| abstract_inverted_index.later | 290 |
| abstract_inverted_index.learn | 293 |
| abstract_inverted_index.media | 52, 103, 167 |
| abstract_inverted_index.noted | 361 |
| abstract_inverted_index.point | 258 |
| abstract_inverted_index.scan, | 327 |
| abstract_inverted_index.shows | 339 |
| abstract_inverted_index.their | 336 |
| abstract_inverted_index.there | 295, 313 |
| abstract_inverted_index.whose | 346 |
| abstract_inverted_index.would | 255 |
| abstract_inverted_index.(AOM), | 104 |
| abstract_inverted_index.(CSOM) | 53 |
| abstract_inverted_index.(EAC), | 430 |
| abstract_inverted_index.1-year | 178 |
| abstract_inverted_index.begins | 82, 122 |
| abstract_inverted_index.blocks | 307 |
| abstract_inverted_index.bone.1 | 24 |
| abstract_inverted_index.canal, | 241, 311 |
| abstract_inverted_index.canal. | 304 |
| abstract_inverted_index.cannot | 138 |
| abstract_inverted_index.chain. | 469 |
| abstract_inverted_index.clear, | 181 |
| abstract_inverted_index.common | 416 |
| abstract_inverted_index.either | 461 |
| abstract_inverted_index.lesion | 345, 353, 364 |
| abstract_inverted_index.middle | 62, 97, 125, 371, 452 |
| abstract_inverted_index.months | 281 |
| abstract_inverted_index.otitis | 51, 102, 114, 166, 229 |
| abstract_inverted_index.result | 443 |
| abstract_inverted_index.rounds | 8 |
| abstract_inverted_index.severe | 111 |
| abstract_inverted_index.simply | 171 |
| abstract_inverted_index.state: | 402 |
| abstract_inverted_index.status | 320 |
| abstract_inverted_index.thinks | 200 |
| abstract_inverted_index.Alvarez | 11 |
| abstract_inverted_index.Chronic | 49 |
| abstract_inverted_index.Editor, | 1 |
| abstract_inverted_index.Fandino | 399 |
| abstract_inverted_index.Fibrous | 403 |
| abstract_inverted_index.absence | 143 |
| abstract_inverted_index.authors | 27 |
| abstract_inverted_index.because | 459 |
| abstract_inverted_index.chronic | 58, 164, 228 |
| abstract_inverted_index.disease | 80 |
| abstract_inverted_index.explain | 388 |
| abstract_inverted_index.fibrous | 18, 356, 377 |
| abstract_inverted_index.finding | 418 |
| abstract_inverted_index.foreign | 236 |
| abstract_inverted_index.glass") | 349 |
| abstract_inverted_index.hearing | 421, 457 |
| abstract_inverted_index.history | 179, 208 |
| abstract_inverted_index.leading | 454 |
| abstract_inverted_index.limited | 226 |
| abstract_inverted_index.mastoid | 65 |
| abstract_inverted_index.media.2 | 115 |
| abstract_inverted_index.medical | 337, 374 |
| abstract_inverted_index.mention | 316 |
| abstract_inverted_index.obvious | 218 |
| abstract_inverted_index.otalgia | 212 |
| abstract_inverted_index.patient | 16, 199, 276, 331 |
| abstract_inverted_index.present | 248 |
| abstract_inverted_index.provide | 28 |
| abstract_inverted_index.respond | 334 |
| abstract_inverted_index.through | 74 |
| abstract_inverted_index.treated | 278 |
| abstract_inverted_index.unusual | 411 |
| abstract_inverted_index.usually | 81 |
| abstract_inverted_index.without | 392 |
| abstract_inverted_index.("ground | 348 |
| abstract_inverted_index.Stenosis | 437 |
| abstract_inverted_index.article, | 157 |
| abstract_inverted_index.auditory | 303, 310, 368, 428 |
| abstract_inverted_index.concerns | 40 |
| abstract_inverted_index.diagnose | 139 |
| abstract_inverted_index.evidence | 145 |
| abstract_inverted_index.externa, | 230 |
| abstract_inverted_index.external | 243, 302, 309, 367, 427 |
| abstract_inverted_index.fallacy, | 219 |
| abstract_inverted_index.insights | 30 |
| abstract_inverted_index.interest | 5 |
| abstract_inverted_index.membrane | 77, 149 |
| abstract_inverted_index.otalgia. | 191 |
| abstract_inverted_index.otorrhea | 73, 210 |
| abstract_inverted_index.patients | 203 |
| abstract_inverted_index.presence | 175, 341 |
| abstract_inverted_index.presents | 67 |
| abstract_inverted_index.sequelae | 108, 385 |
| abstract_inverted_index.specific | 284 |
| abstract_inverted_index.stenosis | 424 |
| abstract_inverted_index.suggests | 193 |
| abstract_inverted_index.symptoms | 391 |
| abstract_inverted_index.temporal | 23, 231, 381, 407 |
| abstract_inverted_index.therapy, | 338 |
| abstract_inverted_index.tympanic | 76, 88, 135, 148, 323 |
| abstract_inverted_index.valuable | 29 |
| abstract_inverted_index.childhood | 84 |
| abstract_inverted_index.described | 55 |
| abstract_inverted_index.describes | 383 |
| abstract_inverted_index.diagnosis | 162, 272, 396 |
| abstract_inverted_index.discharge | 71, 183 |
| abstract_inverted_index.dysplasia | 19, 378, 404 |
| abstract_inverted_index.extension | 449 |
| abstract_inverted_index.framework | 44 |
| abstract_inverted_index.highlight | 38 |
| abstract_inverted_index.indicates | 350 |
| abstract_inverted_index.infection | 94, 121 |
| abstract_inverted_index.involving | 405 |
| abstract_inverted_index.membrane. | 136, 324 |
| abstract_inverted_index.ossicular | 468 |
| abstract_inverted_index.patients. | 436 |
| abstract_inverted_index.physician | 196 |
| abstract_inverted_index.presented | 154 |
| abstract_inverted_index.recurrent | 69 |
| abstract_inverted_index.regarding | 41 |
| abstract_inverted_index.resorting | 393 |
| abstract_inverted_index.secondary | 445 |
| abstract_inverted_index.symptoms. | 253 |
| abstract_inverted_index.apparently | 306 |
| abstract_inverted_index.associated | 129, 188, 417 |
| abstract_inverted_index.carcinoma, | 233 |
| abstract_inverted_index.conditions | 221 |
| abstract_inverted_index.conductive | 420, 456 |
| abstract_inverted_index.describing | 14 |
| abstract_inverted_index.diagnostic | 43 |
| abstract_inverted_index.dysplasia. | 357 |
| abstract_inverted_index.evaluating | 197 |
| abstract_inverted_index.heuristic. | 270 |
| abstract_inverted_index.literature | 375 |
| abstract_inverted_index.management | 283 |
| abstract_inverted_index.presenting | 204 |
| abstract_inverted_index.whatsoever | 317 |
| abstract_inverted_index.description | 347 |
| abstract_inverted_index.obliterates | 365 |
| abstract_inverted_index.obstruction | 463 |
| abstract_inverted_index.patient’s | 390 |
| abstract_inverted_index.perforation | 89, 132 |
| abstract_inverted_index.significant | 39 |
| abstract_inverted_index.spontaneous | 87 |
| abstract_inverted_index.suppurative | 50, 165 |
| abstract_inverted_index.availability | 266, 269 |
| abstract_inverted_index.inflammation | 59 |
| abstract_inverted_index.intermittent | 190 |
| abstract_inverted_index.perforation. | 78, 150 |
| abstract_inverted_index.presentation | 9 |
| abstract_inverted_index.approximately | 433 |
| abstract_inverted_index.cholesteatoma | 245, 447 |
| abstract_inverted_index.demonstration | 263 |
| abstract_inverted_index.fibro-osseous | 352 |
| abstract_inverted_index.long-standing | 235 |
| abstract_inverted_index.presentation, | 34, 412 |
| abstract_inverted_index.erosion/fixation | 465 |
| abstract_inverted_index.non-foul-smelling | 182 |
| cited_by_percentile_year | |
| countries_distinct_count | 1 |
| institutions_distinct_count | 1 |
| citation_normalized_percentile.value | 0.80107006 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |