Chondrodermatitis Nodularis Helicis

In chondrodermatitis nodularis chronica helicis, sometimes known as Winkler's disease, a small nodule forms on the auricle, usually in the superior portion of the helix. Pain is always a prominent feature.

Histological examination of biopsies of such lesions in which the elastic cartilage underlying the skin of the auricle is particularly well-represented, shows ulceration of the skin of the auricle and complete necrosis of the tip of the underlying elastic cartilage of the auricle. In some cases a piece of extruded necrotic cartilage may be seen on the floor of the ulcer. The perichondrium of the elastic cartilage in this region shows obstructive thickening of small arteries.

The helix is one of the furthest points from the source of the arterial blood supply of the pinna. It seems likely that obstruction of small arteries of the perichondri-um is the primary lesion leading to cartilage necrosis, and that the acute inflammation and epidermal ulceration are secondary to the nearby cartilage necrosis. An association between chondrodermatitis nodularis helicis and systemic sclerosis has been described [12]. In this condition obstructive changes are frequently found in small arteries.

In keratosis obturans the keratin produced by exfoliation from the skin of the tympanic membrane and external canal is retained on the epithelial surface and forms a solid plug. This enlarges and may cause circumferential erosion of the bony canal. Keratosis obturans is probably the result of a defect of the normal migratory properties of the squamous epithelium of tympanic membrane and adjacent ear canal that causes the accumulation of keratinous debris [20]. A minor degree of this process -keratosis of the tympanic membrane - in which deposits of keratin grow on the eardrum and cause tinnitus has also been found to be associated with absent or defective auditory epithelial migration [103].

A condition that has been distinguished from keratosis obturans is cholesteatoma of the external canal. In this lesion epidermoid tissue appears to penetrate into the wall of the deep external canal causing localised os-teonecrosis and bone erosion [87].

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