ORIG INAL ARTICLE
Auricular ossification resulting in
external auditory canal stenosis
Matthew J. Carfrae, MD; David Foyt, MD
Abstract
We report thecaseofa49-year-oldman whopresentedwith
left auralfullness, hearing loss, and a stenoticleft external
auditorymeatus.Physicalexaminationand computedto-
mographyrevealed thepresence ofan idiopathicossification
of the cartilaginous auricle and externalauditory canal.
The patient was successfully treated with meatoplasty.
Pathologic examinationoftheremovedspecimen revealed
osseous metaplasia.
Introduction
The petrified auricle is a rare clinical entity in which
all or part or the auricle becomes immobile as a result
of ectopic calcification or ossification . The process of
petrification can be initiated by local injury secondary
to frostbite, physical trauma, or an inflam matory or
systemic disease. The difference between ossification
and calcification of th e auricular cart ilage cannot be
ascertained clinically; the disti nction can be made only
by histologic evaluation.' Calcificatio n is th e more
common cause.
Auricular ossification may be bilateral or un ilateral,
and it is more common in males. We report a case of
auricular ossification in a man who presen ted with left
aural fullness, cond uctive hearing loss, and a stenotic
left external audi tory meatus.
Case repo rt
A 49-year-old man presented with left aural fullness and
a IS-dB hearing loss. He denied otalgia and otorrhea
and a history of frostbite or trauma. The remainder of
his medical histor y was unremarkable, and he took no
medications.
From the Division of O tolaryngology, Department of Surgery, Albany
(N.Y.) Medical College (Dr. Carfrae), and th e Capital Region Ear
Institute, Slingerlands, N.Y. (Dr. Foyr).
Corresponding au tho r:David Foyt,MD ,Capital Region Ear Institut e, 1220
New Scotland Rd., Suite 301,Slingerlands, NY 12159. Phone: (518)
439-4326; fax: (518) 439-6143 ; e-mai l: albanyeardoc@yahoo .com
148 ' www.entjournal.com
On examination, both aur icles were immobile and
had a firm, bony consistency, but only th e left aur icle
was symp tomat ic.Th e left external auditory meatu s was
stenotic and almos t completelyoccluded.Com puted to-
mography (CT) of the left temporal bone demonstra ted
that the density of the auricular carti lage was similar to
that of bone (figure 1). •
The patient underwent meatoplasty. During the pro-
cedure, he was found to have ossification of the external
auditory meatus . The ossification was remove d with a
drill and rongeur. Pathologic examination revealed a
bony deposition in the auricular cartilage (figure 2).
Postoperatively, the conductive component of the
patient's hearing loss improved.The ear canal was patent
and able to be cleaned . The contralateral ear remained
asymp tom atic.
Discussion
Auricular ossification is for the most part asymptomatic,
altho ugh some patient s report discom fort at night sec-
on dary to pressure on th e pinna du ring sleep. Patients
may experie nce a gradual stiffening of the pinna over
time. Examina tion of the pinna will reveal th at the
rigidity does not involve the earlo be. Radiographic
evaluation will show an increase in the density of the
auricular cartilage that is consistent with ossification or
calcium deposition.
The process of ectopic ossification begins with the
production of bone morphogenetic protein, which
leads to the release of a cascade of mediators that re-
sults in the formation of bone. 2 By contrast,calcification
of otherwise normal tissue can be found throughout
the body. Calcification can be initiated by deposition
of the mineral in tissue th at has been damaged by
frostbite, mecha nical trauma, and certa in systemic
conditions . Additionally, secondary calcification can
occur as a result of aberrations in calcium metabolism.
Petrifi cation of th e auricles is caused more often by
calcificatio n th an by ossification.
ENT-Ear, Nose & Throat Journal' March 2008
 AURICULAR OSSIFICATION RESULTING IN EXTERNAL AUDITORY CANAL STENOSIS

Among them are hypertension, alkaptonuria, systemic

chondromalacia, relapsing polychondritis, and familial
cold hypersensitivity." Other systemic diseases associ-
ated with petrified auricles are sclerod erm a,acromegaly,
diabetes mellitus, hypopituitarism, and hypothyroid-
ism.' Our patient's disorder was idiopathic, as he had
no history of inciting conditions.
There is little information regarding the treatment of
this disorder. Wedge resection of a calcified auricle has
been reported as a cure for insomnia.' Our pati ent was
successfully treated with meatoplasty to relieve stenosis
of the external auditory canal secondary to ossification
of the auricle and lateral meatus.
Figure 1. High-resolution axial CT of the left temporal bone shows
the increased density of theleft auricularcartilageand the resulting References
stenosis of the external auditory meatus. I. Str umia R, Lombard i AR,Altieri E. The pe trified ear-a manifesta-
tion of dystrophic calcification . Derma tology 1997;194(4):371- 3.
2. DiBart olom eo IR. The petrifi ed aur icle: Com ments on ossifica-
Th e most common cause of auricular ossification tion , calcification and exostoses of th e externa l ear. Laryngoscop e
1985;95(5):566-76.
is severe frostbite. Hypothermia leads to thrombosis, 3. Stites PC, Boyd AS, Zic I. Aur icular ossificans (ectop ic ossification
ischemia, and a proliferation of lamellar bone.' Other of th e aur icle). I Am Acad Derma toI2003;49 (1) :142-4.
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frostbite, repeated manipulation ofthe pinna, mechani- 5. Lister GO. Oss ification in th e elastic cartilage of the ear. Br I Surg
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bites. Auricular ossification has also been associat ed
with inflammatory conditions such as chondritis, peri-
chondritis, and syphilitic perichondritis, as well as with REPRINTS REPRINTS REPRINTS
(f)
neopl asms such as nevi of the face, pilomatrixoma, and f-
chondroid syringoma.' Finally, many systemic diseases Z Reprints of articles published in ENT
can lead to auricular ossification, including congenital a:
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plaque-like osteomatosis, Albright hereditary osteo- ill JOURNAL are available (in quantities
dystrophy, fibrodysplasia ossificansprogressiva,Addison a:
disease, osseous heteroplasia, and collagen vascular (f) of 500 or more) by contacting:
diseases, especially CREST syndrome and childhood f-
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dermatomyositis.'
Some systemic diseases have been associat ed with a: Katie Kramer
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auricular calcification but not ectopic ossification. ill
a: PARS International Corp.
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f- 212-221-9595, x 324
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a: katie.kramer@parsintl.com
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Figure 2. Photomicrograph of the specimen removed from the left

auricle demonstrates osseous metaplasia of the cartilage, marrow
spaces, and lamellar bone.

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