"Pseudocyst of the auricle", othematoma and otoseroma: three faces of the same coin?

Cystic swellings of the choncha of the ear without serious inflammation are routine findings for otolaryngologists. They are frequently diagnosed as othematoma or otoseroma and may be caused by traceable traumas or microtraumas. "Pseudocyst of the auricle" is defined as intracartilaginous cavity lacking epithelial lining. Thus, according to previous reports "pseudocysts" are supposed to occur due to chondromalacia within the cartilage. We recently observed four cases of "pseudocyst of the auricle" characterized by non-inflammatory, merely painless swellings on the anthelix part of the ears without history of any previous trauma. Incisional biopsies were taken from the dorsal side of the concha and freed 2 to 2.5 ml of viscous serous fluid. Histopathological examination of biopsy specimens showed regular epidermis overlying normal reticular dermis and perichondrium as well as regular cartilage in all patients. In the fourth patient the biopsy, additionally, revealed a tiny intracartilaginous cavity measuring 1 x 4 micrometers in diameter. Histopathologically "pseudocysts of the auricle" are reported to represent small intracartilaginous hollows lacking epithelial linings. Following previous descriptions they are located within the cartilage of the concha of the ear. Because of the small size of the intracartilaginous cavity they are unable to contain more than a few microliters of fluid. Therefore cystic swellings of the auricle containing comparatively large amounts of serous liquid must be located outside the cartilage. In this context the concept of "pseudocyst of the auricle" as reported, can only be seen as the third face of a coin that shows othematoma on the one and otoseroma on the other side.