Persistent foramen of Huschke: Presentation, evaluation, and management

OBJECTIVE: Describe the presentation and management strategy for patients with symptomatic foramen of Huschke (FH). PATIENTS: Adults with persistent FH confirmed on imaging. INTERVENTIONS: Diagnosis and management of symptomatic persistent FH. MAIN OUTCOME MEASURE: Resolution of otologic symptoms. RESULTS: A total of four patients with symptomatic, radiographically‐confirmed persistent FH were included. The majority of patients endorsed otalgia (n = 4) and otorrhea (n = 3), and only one patient was noted to have a conductive hearing loss. All patients were noted to have dynamic movement of an external auditory canal mass with mandible manipulation on examination, and all patients had an identifiable fistula on imaging. Patients underwent surgical intervention, including both preauricular (n = 2) and transcanal (n = 2) approaches, and all endorsed symptomatic resolution after convalescence. CONCLUSIONS: Persistent FH remains an uncommon and potentially underrecognized cause of otologic symptoms. Diagnosis requires a high index of suspicion, and one must rely on both key examination findings and imaging to confirm this diagnosis. In appropriately selected patients, surgical intervention can provide durable symptomatic resolution. LEVEL OF EVIDENCE: IV