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Histopathological Examination of Ear Biopsy - Middle Ear

Dr Sampurna Roy MD


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Specimens from the middle ear are less often received than those from the external ear.

Those more commonly received include tissues with inflammatory conditions, cholesteatoma, small specimens from ossicles, larger specimens from the mastoid air cells and other rarer specimens such as "petrosectomies".

Visit: Ear Biopsy: Clinical Details required for the DiagnosisHistopathological Examination of Ear Biopsy - External Ear ; Histopathological examination of Ear Biopsy- Inner Ear.

Histopathology report:

Specimens taken for the diagnosis and treatment of chronic inflammatory conditions :

The report should comment on whether there is:

- Mucosal inflammation: acute, chronic, nonspecific, granulomatous, eosinophilic;

- Involvement of :  ossicles;  middle ear glands;  bony septa of mastoid air cells;

- Presence of : i) cholesterol granulomas ;  ii) fibrosis;  iii) tympanosclerosis;

- Stratified squamous epithelium with keratin in cholesteatoma.

Specimens of Ear Polyp:

The report should comment on :

- The type of covering epithelium:  columnar, ciliated, or stratified squamous ;

- Inflammation:  type and severity ; associated granulation tissue ;

- The presence of middle ear glands.

- Foreign body giant cell reaction to:  keratin squames which suggests cholesteatoma ; hair shafts ; starch granules.

Stapedectomy specimens for otosclerosis:

The stapes has a footplate that articulates with the temporal bone at the oval window, a head that articulates with the incus, and two crura which link the two.

All of the stapes may be excised, or occasionally the footplate may be left behind.

Otosclerotic bone is seen only in the footplate near the anterior or posterior crus, and so may not be evident when only the head and crura of the stapes are removed.

In some cases, the otosclerotic process affects only the temporal bone and the oval window, and the entire stapedectomy will then show no significant pathological abnormality.

The report should comment on:

- presence and integrity of the footplate and arch of the stapes ;

- otosclerosis ;

- inflammation of mucosa included with the specimen ;

- intensity of the inflammatory cell infiltrate ;

- vascularity of the bone, mucosa and other tissues.

Specimens for the diagnosis and treatment of neoplasia:

The report should comment on :

- the type and differentiation of the tumour;

1. Middle Ear Adenoma (with or without neuroendocrine differentiation);

2. Squamous Cell Carcinoma;

3. Adenocarcinoma ;

4. Paraganglioma ;

5. Meningioma ;

- whether the ossicles are involved by tumour ;

- the presence of middle ear glands, middle ear cuboidal epithelium, tympanic membrane tissue ;

"Petrosectomy" specimens for carcinoma:

This is never an excision specimen of petrous bone, but consists of external and middle ear tissues.

The report should list the tissues present: 

- Such as external ear structures, ossicles and tympanic membrane.

In addition the report should comment on:

- the type of neoplasia ;

- the tissues involved by the neoplasm ;

- the sites of origin of tumour, such as external canal, tympanic membrane, middle ear epithelium ;

- the proximity of the tumour to excision margins.


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Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)







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