(0517) Exploring Otophyma: A Systematic Review on Etiology, Clinical Characteristics, and Management Strategies

Introduction: Otophyma is a rare condition marked by the enlargement of the external ear, attributed to chronic inflammation. Otophyma is distinguished by histopathology that often presents as part of the rosacea spectrum, including sebaceous hyperplasia, fibrosis, and localized lymphedema. This study aims to comprehensively review otophyma, covering its etiology, clinical features, and management strategies to inform clinical practice.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocol, PubMed and Embase was queried for articles published from January 2000 - January 2024 describing patients suffering from otophyma by two independent reviewers. The methodological index for non-randomized studies (MINORS) criteria was used to assess quality of studies.

Results: Of 258 abstracts identified, 14 articles met the inclusion criteria, comprising a total of 17 patients. The average age was 53 years (31-73y), with 70% being male (n = 12). Unilateral ear involvement was present in 35% (n = 6). The most common etiologies were phymatous rosacea (35%, n=6) and chronic otitis externa (23%, n=4), but many patients had no history of skin conditions. Histological findings included perifolliculitis, sebaceous gland hyperplasia, dermal telangectasia, and Demodex infestation. Obstruction of the external auditory canal resulted in conductive hearing loss in 35% of patients (n = 6). Medical management with isotretinoin demonstrated at least partial improvement in 47% of patients (n = 8). Excisional debulking, electrosurgery, meatoplasty/canalplasty were definitive management options for medical treatment failure.

Conclusions: Otophyma, a rare yet impactful condition, has the potential for disfigurement and may lead to hearing loss. Obtaining biopsy with histology is recommended to rule out other connective tissue conditions or neoplastic processes. Treatment modalities span from medical therapies to surgical interventions, with the selection based on the severity and chronicity of the condition.