Imaging Although imaging is not required to yield a diagnosis, it may be obtained to exclude other disorders, such as a concurrent cholesteatoma. Pathology By gross description, there is usually a solitary, polypoid, reddish mass behind an intact ear drum (tympanic membrane). The tissue is often friable, measuring <2 cm in most cases. All tissue should be processed in order to exclude a concurrent cholesteatoma. By microscopic exam, the polypoid appearance is maintained, showing a granulation-type tissue reaction with edematous stroma and a rich investment by capillaries. The surface of the polyp is covered by stratified squamous epithelium with a prominent granular cell layer. The tissue is filled with lymphocytes, plasma cells, mast cells, histiocytes, and eosinophils. It is not uncommon to see plasma cells with Russell bodies and Mott cell formation. Depending on length of symptoms, multinucleated giant cells and calcifications may be seen. Other disorders may be concurrently present, especially since this is a post infectious/inflammatory disorder, and these include a cholesterol granuloma, "tunnel clusters" (glandular epithelial inclusions below the surface epithelium), and cholesteatoma. Immunohistochemistry Immunohistochemistry is unnecessary for the diagnosis, but will highlight a mixed B- and T-cell population within the lymphoid component, without light chain (kappa or lambda) restriction. Any muscle markers would be negative. Differential diagnoses The lesion presents in young patients, so the differential for a "polyp", especially when the lymphoid component is crushed or dominant, would include a rhabdomyosarcoma, extramedullary plasmacytoma, and a neuroendocrine adenoma of the middle ear.
Otic polyp
Nasal polyp
Nasal septal abscess
Laryngeal cyst
Oral mucocele
Laryngeal papillomatosis
Salivary gland fistula
Laryngocele