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Pathology of Petrified Ear (Idiopathic Auricular Ossificans)

Dr Sampurna Roy MD       



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Cutaneous ossification is classified as primary when it arises de novo and secondary if it occurs within a preexisting lesion. 

Bochdalek first reported a case of petrified auricle in a cadaver in 1866. Wassmund first reported the X-ray findings of this condition in 1899.

Petrification of the auricle, whether by calcification, ossification, or otherwise, is an uncommon condition. 

Elastic cartilage of the auricle is normally highly malleable and painless to manipulate.

Upon calcification or ossification of the auricle, it becomes difficult to maneuver and rock hard or petrified.

Petrification of the auricular cartilage has been attributed to dystrophic calcification, metastatic calcification, and ectopic ossification.

Ectopic ossification represents an unusual cause of a petrified ear.

It occurs through deposition of calcium and phosphorus in a proteinaceous matrix as hydroxyapatite crystals, and by definition it occurs in soft tissue, which does not normally ossify.

Clinical presentation of petrified auricle :  Although most patients are asymptomatic, some may have discomfort with the application of pressure.

There may be gradual stiffening of the appendage.

Bilateral involvement is more frequent than unilateral lesion. 

Physical examination :  Typically reveals a rigid auricle and spared lobule, without any visible cutaneous abnormality.

Causes of petrified auricle : 

Severe hypothermia was the most common cause of auricular ossificans ; secondary to repeated exposure to cold temperatures ; mechanical trauma ; radiation therapy ; insect bites ; various inflammatory conditions including chondritis ; perichondritis ; syphilis ; endocrinopathies such as hypopituitarism, diabetes mellitus ; acromegaly and hypothyroidism have also been associated with petrification of the auricle.

Adrenal insufficiency should be considered when auricular ossification is encountered.

The pathogenesis of this phenomenon is complex and not well understood.

Petrified ear has been associated with serious, potentially life-threatening, endocrine, and metabolic disorders, such as cortisol deficiency.

Further reading:

Bilateral Ossification of the Auricular Cartilage.

A rare case of petrified ear.

Ears "made of stone" - unusual secondary phenomenon of undersubstituted adrenal insufficiency .

Bilateral ossification of the auricles: an unusual entity and review of the literature.

Ossification of the external ear: a case report and review of the literature.

Idiopathic bilateral auricular ossificans: a case report and review of the literature.

Auricular ossification.

The petrified ear.

Auricular ossificans (ectopic ossification of the auricle)

The petrified auricle: comments on ossification, calcification and exostoses of the external ear.

Petrified ear--a case of calcinosis cutis.

Acrobatic ears: a cause of petrified auricles.

The petrified auricle: comments on ossification, calcification and exostoses of the external ear.

Acrobatic ears: a cause of petrified auricles.

Ossification of the auricle in Addison's disease.




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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