Finding the Silver Bullet for Persistent Foramen Hushke

Abstract

We report a case of persistent foramen Hushke and embark on a literature search from 1990 to 2021. The search was done using electronic databases of PubMed and Google Scholar using the MESH words 'TMJ herniation', 'persistent foramen Hushke', 'TMJ prolapse', 'EAC dehiscence', and 'ear canal mass'. A total of 37 other case reports were included after excluding duplicates and non-English publications. The most common presentations, treatment modalities, complications, and outcomes were discussed. Common presentations include otalgia, tinnitus, otorrhea, and aural fullness. Surgical intervention shows a good outcome, whereas conservative treatment shows a mixed response. Despite the overwhelming success of surgical interventions in treating symptomatic persistent foramen of Hushke, it is still early to establish a guideline to manage these patients, as this condition is rare and presents with variable symptoms. More high-quality studies and a long-term follow-up of the patients may be essential to observe and compare the outcome and recurrence rate of temporomandibular joint (TMJ) herniation.

Keywords: ear canal mass; external auditory canal dehiscence; persistent foramen hushke; temporomandibular joint prolapse; tmj herniation.

Figure 1. Clinical image showing the TMJ prolapse into external ear canal during opening (A) and closing of mouth (B).

Image credit: Theresa Teoh.

Figure 2. Radiological image of the temporal bone showing defect at anterior wall of bony ear canal.

Image credit: Theresa Teoh.

Figure 3. Bar chart showing number of cases and their presenting complaint.

Image credits: Theresa Teoh.

Figure 4. Pie chart showing percentage of choices of management.

Image credits: Theresa Teoh.