Ear foreign-body removal: a review of 98 consecutive cases

Although patients with external auditory canal foreign bodies present frequently, there is scant literature on the topic other than case reports. A study of 98 consecutive patients referred over a 1-year period to otolaryngologists at a large urban county hospital was undertaken. Fifty-seven percent of these patients were over 12 years of age. A data form was completed by the otolaryngology resident removing the foreign body. Fifty-three percent of the cases had undergone one or more previous attempts at removal prior to the otolaryngologist's attempt, usually by an emergency room physician. Method of removal included use of a microscope in only 6% of previous attempts, while otolaryngologists used a microscope in 91%. Canal wall lacerations were present in 48% of patients following previous attempts at removal by other health-care professionals, but were found in only 4% of removals by an otolaryngologist. Recommendations include use of a microscope for removal and referral to an otolaryngologist if the foreign body is not readily removed by the primary-care physician.

Posterior dislocation of mandibular condyle into external auditory canal. A case report

A case is reported of a 49-year-old edentulous patient who suffered a posterior dislocation of the right fractured mandibular condyle causing a fracture of the tympanic plate. This was associated with a right transverse fracture of the petrous bone and an intact tympanic membrane. Some of the problems related to this condition are discussed.

Traumatic external auditory canal atresia

Gunshot injuries in the periauricular region can result in massive tissue distortion and destruction. The soft tissue effects can be so dramatic that otologic abnormalities can be initially overlooked, especially by non-otolaryngologists. Delayed stenosis or complete closure of the external auditory canal can occur. We present two cases of post-traumatic ear canal atresia that were initially overlooked by non-otolaryngologists, until secondary plastic reconstructive operations were performed in which preauricular skin incisions entered into large canal cholesteatomas. These canal cholesteatomas resulted from total obstruction of the external auditory canal after trauma.

Lightning and its effects on the auditory system

Patients struck by lightning can present with a wide variety of unusual otologic problems including burns to the external auditory canal, tympanic membrane rupture, middle ear injury, and sensorineural hearing loss. Four patients who incurred various otologic problems, including one patient with previously unreported bilateral oval window fistulas following lightning injury, are presented. Audiologic, otologic, and surgical findings are reviewed as well as patient follow-up and outcome.

Sequelae of experimental tympanic and inferior canal wall perforations: the double meaning of epithelial migration

The term "epithelial migration" has been used to describe both the normal surface movement of the tympanic epithelium and the movement of epithelial basal cells in repair processes. In an attempt to distinguish between these two processes and to determine their role in the repair of a wounded tympanic membrane, 20 guinea pig tympanic membranes were perforated inferiorly and tattooed with ink through an external incision. Sequential histology of whole temporal bones at intervals from the time of injury up to three weeks showed evidence of movement of the superficial layers of epidermis which was effective in the clearance of cellular debris but not in the closure of the perforation. Drum closure was effected more by the accumulation of exudate and epithelial hyperplasia. The migration of the epithelial basal cells was slow when compared to surface movement. It is suggested that tympanic epithelial surface movement is best described by a passive term such as "epithelial displacement" and that the term migration should be restricted to the activities of the living layers of epidermis.

Auditory canal haemorrhage following mandibular condylar fracture

A case of haemorrhage from the external auditory meatus associated with condylar fracture is presented. It is important that haemorrhage from the ear following maxillofacial injuries be investigated thoroughly because displacement of the condyle into the middle cranial fossa also presents in this manner. The patient was treated by intermaxillary fixation and packing of the auditory canal. Packing is not only effective for haemostasis but is also important in preventing subsequent stenosis of the auditory canal.

Alkaline battery foreign bodies of the ear and nose

Button batteries as foreign bodies are dangerous because of their ability to cause liquefaction necrosis on contact with moist tissue. We treated two patients with disk batteries in the ear and nose. Both patients had severe local reactions, necessitating prolonged treatment. Prompt identification and rapid removal of these foreign bodies is recommended.

Gunshot injuries of the temporal bone

Concurrent with the increase in handgun crime in the United States is a rising incidence of gunshot wounds to the temporal bone. These injuries present challenging diagnostic and management problems to the otolaryngologist. A timely multicenter review of this entity revealed 22 cases evaluated and treated by the authors between 1975 and 1984. A wide variety of injuries were encountered, involving anatomic structures within or contiguous with the temporal bone. These included: eight intracranial injuries; 11 traumatized facial nerves; seven vascular wounds; 19 mastoid, middle, or inner ear injuries; and 11 cases of damage to the external auditory canals. A rational scheme for immediate and long-term management of each type of injury is outlined. Illustrative cases representing vascular, neural, temporal bone, and central nervous system injury are presented.

Tympanomastoid surgery: a technique for repairing posterior osseous canal wall defects with autologous temporalis fascia and bone pâte

A technique for repairing small to medium-sized defects in the osseous posterior superior canal resulting from pathologic or iatrogenic causes is described. Bone pâte is harvested from the mastoid cortex by means of a simple collection technique. A sandwich graft composed of autologous temporalis fascia lined with bone pâte is used to fill in the canal wall defect. This technique has been used successfully in 27 of 28 cases, with follow-up as long as 8 years. When fully healed, the bone graft has attained the texture and consistency of the normal osseous canal and, if necessary, can be curetted or drilled for reshaping during planned second-stage tympanomastoid surgery. The temporalis fascia/bone pâte graft technique is simple, easy to learn, and has proven to be a reliable method for repairing the defects described.

Complications associated with the surgical treatment of cholesteatoma

The surgical complications associated with a cholesteatoma are predictable preoperatively depending upon the location of a cholesteatoma. If the patient has an attic cholesteatoma the surgeon can anticipate postoperatively a dry ear, minimal chance of a persistent or recurrent cholesteatoma, a satisfactory hearing restoration, and, although a mastoidectomy is usually necessary, the size of the mastoid cavity in an adult can be extremely small. If a patient has a middle ear cholesteatoma the surgeon can anticipate postoperatively a relatively high incidence of moist ears, persistent or recurrent cholesteatoma, and an unsatisfactory hearing result. However, rarely will the creation of a mastoid cavity be necessary as rarely will mastoidectomy be required. Although most of the children "before puberty" in the study had middle ear cholesteatomas, all children, regardless of the location of cholesteatoma, had a higher incidence of surgical failure than did adults.

Management of canal stenosis with a transposition flap

Stenosis of the external auditory canal is difficult to manage. Numerous surgical procedures have been advocated for its correction and all function to varying degrees, but repeat stenosis remains a problem. Our experience, with the use of a superiorly based preauricular transposition flap in combination with an endaural and postauricular approach in 5 patients, 8 ears, is presented. In 3 patients, 5 ears, the stenosis was congenital; in 1 patient, 1 ear, traumatic; and in 1 patient, 2 ears, secondary to chronic external otitis. With a follow-up of 1 to 9 years, the functional and cosmetic results have been satisfactory in all cases.