40-year-old with an Ear Lesion

A 40-year-old male with no complaints had a routine ear exam. He has no complaints, although he notes that about a week ago, he used a Q-Tip in his ear, and it caused discomfort. The following image of his left ear was obtained with the Wispr Digital Otoscope.

What is the next step in management?

A. No action is necessary: it is an osteoma.
B. No action is necessary:  it is an exostosis.
C. Referral to otolaryngology (ENT) for evaluation.
D. Initiation of antibiotics.

The lesion has a domed, vascular appearance. This is not consistent with either an osteoma or an exostosis. An osteoma is a benign growth that often appears pediculated. Exostosis is a benign bony overgrowth often associated with cold water swimming. There is no indication that this is an infection, such as acute otitis media (AOM), requiring antibiotics.

This may be a cyst that was irritated by the Q-Tip a week ago, causing the erythematous (red) appearance. It’s also possible that it is a pyogenic granuloma, a benign vascular tumor. ENT should be consulted for evaluation and possible biopsy.

Here is the complete video exam