Burow's solution, 13%
aluminum acetate dissolved in water developed as ear drops by German Dr. Karl August Burow in the mid-1800s, was confirmed by Mahoney (1980) and Thorp et al. (2000) to act on chronic
suppurative otitis media without
ototoxicity. We have found it satisfactory in treating
otitis media and other intractable
inflammation and
fungal infection of the external auditory canal. We report its potent effect in 2 cases of external auditory canal
cholesteatoma (EACC) and 1 of mastoid cavity
cholesteatoma (MCC)-the first such report insofar as we knew. Case 1 of EACC involved an 8-year-old boy with
cholesteatoma debris in a bony groove evidencing defective skin just posteroinferior to the left tympanic membrane. EACC was cured after a single
Burow's solution instillation. Case 2 of EACC was a 31-year-old woman whose left ear canal was filled by a
keratin mass with
pus positive for methicillin-resistant staphylococcus aureus (MRSA) and granulation and experiencing
otalgia and
dysgeusia. Computed tomography (CT) showed that the bony anterior and posterosuperior wall of the external auditory canal had been destroyed. The EACC was removed and
Burow's solution instilled once a week, effecting a cure about one month later, leaving the bony groove of the anterior and inferior wall intact and recovering gustatory sensation. Case 3 of MCC was a 47-year-old man undergoing right canal wall down
tympanoplasty three times. One year after the last surgery, the mastoid cavity and posterior external canal wall was covered by a
cholesteatoma matrix with granulation and
pus. Instilling
Burow's solution for 5 months resulted in a completely dry
cholesteatoma-free cavity. All three subjects had intact tympanic membranes.
Burow's solution alone proving effective against EACC and MCC suggests its great usefulness as first-choice
conservative therapy. Although this usually cannot completely cure middle-ear and attic
cholesteatoma, its effectiveness in cases of EACC and MCC should be recognized in
infection and
inflammation with
cholesteatoma.