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Xu Y, Bei Z, Li M, Ye L, Chu B, Zhao Y, Qian Z. Biomedical application of materials for external auditory canal: History, challenges, and clinical prospects. Bioact Mater 2024; 39:317-335. [PMID: 38827173 PMCID: PMC11139775 DOI: 10.1016/j.bioactmat.2024.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/14/2024] [Accepted: 05/19/2024] [Indexed: 06/04/2024] Open
Abstract
Biomaterials play an integral role in treatment of external auditory canal (EAC) diseases. Regarding the special anatomic structure and physiological characteristics of EAC, careful selection of applicable biomaterials was essential step towards effective management of EAC conditions. The bioactive materials can provide reasonable biocompatibility, reduce risk of host pro-inflammatory response and immune rejection, and promote the healing process. In therapeutic procedure, biomaterials were employed for covering or packing the wound, protection of the damaged tissue, and maintaining of normal structures and functions of the EAC. Therefore, understanding and application of biomaterials was key to obtaining great rehabilitation in therapy of EAC diseases. In clinical practice, biomaterials were recognized as an important part in the treatment of different EAC diseases. The choice of biomaterials was distinct according to the requirements of various diseases. As a result, awareness of property regarding different biomaterials was fundamental for appropriate selection of therapeutic substances in different EAC diseases. In this review, we firstly introduced the characteristics of EAC structures and physiology, and EAC pathologies were summarized secondarily. From the viewpoint of biomaterials, the different materials applied to individual diseases were outlined in categories. Besides, the underlying future of therapeutic EAC biomaterials was discussed.
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Affiliation(s)
- Yang Xu
- Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhongwu Bei
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mei Li
- Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lin Ye
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bingyang Chu
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhao
- Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhiyong Qian
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Guo L, Yang Y, Liu J, Su Y, Cai Z. Treatment of external auditory canal stenosis and atresia after transcanal endoscopic ear surgery. Am J Otolaryngol 2024; 45:104175. [PMID: 38113773 DOI: 10.1016/j.amjoto.2023.104175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE To discuss the treatment of external auditory canal stenosis or atresia occurring as a complication of transcanal endoscopic ear surgery. MATERIALS AND METHODS We retrospectively analyzed the medical records of 11 patients who developed external auditory canal stenosis or atresia after undergoing transcanal endoscopic ear surgery. The 10 patients with stenosis were treated with external auditory canal expansion via drainage tube insertion; 2 of these patients further received local injections of triamcinolone acetonide. One patient with atresia was treated with meatoplasty surgery followed by tube insertion and triamcinolone acetonide injection. RESULTS The stenosis/atresia improved in all patients, and the external auditory canal was unobstructed without restenosis. CONCLUSIONS Stenosis/atresia of the external auditory canal after transcanal endoscopic ear surgery should be treated with dilation therapy/meatoplasty in a timely manner to prevent progressive hyperplasia of the scar and regain a normal-sized ear canal.
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Affiliation(s)
- Lianrong Guo
- Department of Otorhinolaryngology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, China.
| | - Yuanyuan Yang
- Department of Otorhinolaryngology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, China
| | - Jun Liu
- Department of Otorhinolaryngology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, China
| | - Yongjin Su
- Department of Otorhinolaryngology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, China
| | - Zhi Cai
- Department of Otorhinolaryngology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, China
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Varghese SS, Kumar N, Philipose R. Lateral Stenosis of External Auditory Canal Secondary to Corrosive acid Injury: A Rare Case Report and Review of Literature. Indian J Otolaryngol Head Neck Surg 2023; 75:3889-3894. [PMID: 37974851 PMCID: PMC10645683 DOI: 10.1007/s12070-023-03941-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/06/2023] [Indexed: 11/19/2023] Open
Abstract
Acquired external auditory canal (EAC) stenosis is an uncommon condition with an incidence of 0.6 in 100,000 population. Road traffic accidents and otology surgeries are the frequently reported causes for it to occur. The high rate of restenosis makes this condition difficult to manage. A 50 year old lady presented with history of accidental instillation of acid in her left ear at 6 months of age by the care giver. The patient developed stenosis of left EAC with hearing loss. Examination revealed pin point stenosis of left EAC. Puretone audiogram revealed a moderately severe conductive hearing loss. Computed tomogram showed soft tissue lesion obliterating the entire EAC and extending into the middle ear and antrum. Intra operatively only the cartilaginous EAC was stenosed. Surgical excision of the fibrotic scar with a tympanomastoidectomy and wide meatoplasty was done. Regular post operative aural toileting, packing with merocele strips and application of topical antibiotic -steroid preparations was done. 6 months post-surgery a patent EAC and healed tympanic membrane was achieved. In this report, we present a rare case of lateral EAC stenosis secondary to corrosive acid injury, highlighting the surgical steps, post operative care and surgical outcomes. A limited review of literature is also presented.
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Affiliation(s)
| | - Navneet Kumar
- Department of E.N.T, Chrisitan medical college, Ludhiana, Punjab India
| | - Rebecca Philipose
- Department of E.N.T, Chrisitan medical college, Ludhiana, Punjab India
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Van Oosterwyck R, Loos E, Willaert A. Otological problems in ichthyosis: A literature review. Int J Pediatr Otorhinolaryngol 2023; 173:111714. [PMID: 37714023 DOI: 10.1016/j.ijporl.2023.111714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 07/29/2023] [Accepted: 08/27/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Ichthyoses are a rare group of keratinization disorders characterized by scaling of the skin due to an impaired barrier function. Few studies have addressed ear involvement in patients with ichthyosis, although it is a probably underestimated aspect of the disease. OBJECTIVE This study aims to provide an overview of the otological manifestations in ichthyosis and propose specific treatment options. METHODS Articles were collected using PubMed, EMBASE, and Web of Science. A total of 53 articles were included in this literature review. RESULTS The most common ear problem in patients with ichthyosis is scale accumulation in the ear canals, which can lead to conductive hearing loss and increases the risk of ear infections. Furthermore, some types of ichthyosis are associated with outer ear malformations. Lastly, sensorineural hearing loss is common in syndromic forms of ichthyosis. CONCLUSIONS Otological problems are present in all types of ichthyoses and their treatment is challenging. The involvement of ear, nose, and throat specialists in the routine care of ichthyosis patients is essential for early identification and treatment of these manifestations. More research is needed to provide more insight into the otological problems in ichthyosis and to ameliorate treatment options.
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Affiliation(s)
- R Van Oosterwyck
- University Hospitals Leuven, Department of Otorhinolaryngology-Head and Neck Surgery, Herestraat 49, B-3000, Leuven, Belgium
| | - E Loos
- University Hospitals Leuven, Department of Otorhinolaryngology-Head and Neck Surgery, Herestraat 49, B-3000, Leuven, Belgium; KU Leuven, University of Leuven, Department of Neurosciences, Research Group ExpORL, Leuven, Belgium.
| | - A Willaert
- University Hospitals Leuven, Department of Otorhinolaryngology-Head and Neck Surgery, Herestraat 49, B-3000, Leuven, Belgium
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Mankekar G, Entezami P. Acquired Stenosis of the External Ear Canal. Otolaryngol Clin North Am 2023; 56:919-931. [PMID: 37553271 DOI: 10.1016/j.otc.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Acquired stenosis of the external ear canal (ASEEC) is a relatively uncommon condition. Stenosis or narrowing of the external ear canal (EEC) occurs lateral to the tympanic membrane resulting in a skin lined blind canal. Recurrent otorrhea, and conductive hearing loss are typical clinical features. Although ASEEC can be due to different etiologies, a common pathogenesis, namely an inflammatory cascade, has been implicated. Clinical evaluation, audiogram, and Computed tomography (CT scan) form the mainstay of diagnosis. Surgery is the primary modality for treatment. Restenosis is the most common postsurgical complication.
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Affiliation(s)
- Gauri Mankekar
- Department of Otolaryngology-Head Neck Surgery, Louisiana State University Health, Shreveport, LA, USA.
| | - Payam Entezami
- Department of Otolaryngology-Head Neck Surgery, Louisiana State University Health, Shreveport, LA, USA
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Kamaruzaman F, Ibrahim MIS, Abdullah A. A Rare Case of Idiopathic Bilateral Medial Canal Fibrosis. Cureus 2023; 15:e41830. [PMID: 37575837 PMCID: PMC10423038 DOI: 10.7759/cureus.41830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Medial canal fibrosis usually occurs as sequelae of known conditions such as trauma, infection, or surgery. Rarely, it occurs without an identifiable cause, hence the term idiopathic medial canal fibrosis. Regardless of the etiology, the reportedly most successful treatment is surgery. A 52-year-old lady presented to us with bilateral reduced hearing and left ear tinnitus. There was no significant history to suggest the possible cause of the symptoms. Clinically, there is the presence of thick solid fibrous in the bilateral ear canal. Audiological examination revealed a conductive hearing loss bilaterally with tympanometry of type B, and imaging was done. She successfully underwent canalplasty following that and is doing well to date. In this paper, we reported a rare case of bilateral idiopathic medical canal fibrosis, and we discuss the causes, diagnosis, and best treatment for this disease.
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Affiliation(s)
- Farhana Kamaruzaman
- Otorhinolaryngology - Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Mohd Irman Shah Ibrahim
- Otolaryngology - Head and Neck Surgery, Hospital Sultanah Nur Zahirah, Kuala Terengganu, MYS
| | - Asma Abdullah
- Otolaryngology - Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
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Rat Model of External Auditory Canal Stenosis. Otol Neurotol 2021; 41:e876-e880. [PMID: 32658405 DOI: 10.1097/mao.0000000000002668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS Circumferential electrocautery injury of the rat external auditory canal (EAC) can induce a reproducible animal model of acquired stenosis. BACKGROUND Acquired EAC stenosis may occur as a result of chronic inflammation or trauma to the EAC skin and is characterized by narrowing of the EAC, retention of debris, and hearing loss. Treatment is surgery but it is often complicated by restenosis. A reliable and inexpensive animal model of EAC stenosis has not been described. There have been no studies correlating the extent of EAC injury with the extent of stenosis. METHODS Rats received a 25, 50, or 75% circumferential EAC injury with electrocautery. The extent of resulting stenosis was quantified 21 days following injury. The nature of the injury and healing response was assessed with histology. RESULTS A 25% circumferential injury led to 4 to 34% stenosis (mean, 13%), 50% injury resulted in 43 to 100% stenosis (mean, 73%), and 75% injury resulted in 94 to 100% stenosis (mean=99%, p < 0.0001). The 50% circumferential injury produced 30 to 75% stenosis in five of eight ears, the remainder had >75% stenosis. Wounded ears showed evidence of intact cartilage and epithelium, with increased thickness of the subepithelial layer and localized fibrosis. CONCLUSIONS Electrocautery injury in the ventral aspect of the rat EAC resulted in reproducible EAC stenosis. This rat model may be useful in studying therapy to prevent acquired EAC stenosis due to acute injury. The correlation of the extent of injury (circumference) with resulting stenosis may inform clinical management of EAC injuries.
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Kmeid M, Nehme J. Post-inflammatory acquired atresia of the external auditory canal. J Otol 2019; 14:149-154. [PMID: 32742275 PMCID: PMC7387840 DOI: 10.1016/j.joto.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/17/2019] [Accepted: 07/26/2019] [Indexed: 12/15/2022] Open
Abstract
Acquired atresia of the external auditory canal (EAC) is a rare cause of conductive hearing loss. It has been traditionally classified into 4 categories: traumatic, post-operative, neoplastic and inflammatory. Post-inflammatory acquired auditory canal atresia is thought to be the result of chronic and repetitive infectious bouts affecting the auditory canal. Nevertheless, the underlying pathophysiology of this disorder is yet to be fully elucidated. Current data fail to clearly state the impact that certain underlying systemic disorders may have on the EAC. The possible association to metabolic disturbances such as iron deficiency is also emphasized. In the light of these findings, this analysis can be used to improve the classification of this entity thereby standardizing the assessment of therapeutic approaches.
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Affiliation(s)
- Michel Kmeid
- School of Medicine, Lebanese University, Beirut, Lebanon
| | - Jade Nehme
- Lebanese University, Department of Otolaryngology, Head and Neck Surgery, Beirut, Lebanon
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Hearing Results of Surgery for Acquired Atresia of the External Auditory Canal. Otol Neurotol 2019; 40:S43-S50. [PMID: 31225822 DOI: 10.1097/mao.0000000000002209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate short- and long-term hearing results of surgery for acquired atresia of the external auditory canal (EAC) in a large patient cohort and to define preoperative audiometric conditions useful for patient counseling. STUDY DESIGN Retrospective cohort study. SETTING Academic tertiary referral center. PATIENTS Seventy-eight ears from 72 patients with postinflammatory acquired atresia of the EAC who underwent canal- and meatoplasty were included. Patients with involvement of the ossicular chain, (syndromic) external ear malformations, or congenital aural atresia were excluded. INTERVENTION Canal- and meatoplasty. MAIN OUTCOME MEASURES Mean pure-tone averages of thresholds at 0.5, 1, 2, and 3 kHz (PTA0.5,1,2,3) for air conduction (AC), bone conduction, and air-bone gap (ABG) were calculated preoperatively and at short-term (≤0.55 yr) and long-term follow-up (>0.55 yr). Additionally, the numbers of ears with a closed ABG ≤10 dB and ≤20 dB, and with Social hearing (defined as: AC PTA0.5,1,2,3 ≤35 dB) were assessed. RESULTS At short-term follow-up AC PTA0.5,1,2,3 improved by 18 dB. Social hearing was obtained in 81% of the ears. Postoperatively, 35% of the ears had a closed ABG ≤10 dB, 83% was closed ≤20 dB. During follow-up, significant deterioration of 5 to 7 dB occurred for AC thresholds at 0.25, 0.5, and 1 kHz. CONCLUSIONS Surgery for acquired atresia of the EAC is often beneficial. This study suggests overall advantageous surgery when the preoperative indication criteria ABG PTA0.5,1,2,3 >20 dB and AC PTA0.5,1,2,3 >35 dB are applied.
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Lee YF, Wei PY, Chu CH, Liao WH, Shiao AS, Wang MC. A Retrospective Study to Identify the Relationship Between the Dimension of Osseous External Auditory Canal and Chronic Otitis Media. EAR, NOSE & THROAT JOURNAL 2019; 99:532-536. [PMID: 31155942 DOI: 10.1177/0145561319840884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Whether the dimension of the osseous external auditory canal (OEAC) is related to chronic otitis media (COM) remains an important but unresolved issue. In the literature, routine canaloplasty has been suggested to help elucidate this problem. In this study, we intended to investigate the relationship between the diameter or shape of OEAC and COM. We retrospectively reviewed the high-resolution computed tomography (HRCT) images of the temporal bones of 62 patients with unilateral COM who underwent tympanoplasty from January 1, 2011, to December 31, 2013. For comparison, the HRCT images of another 62 patients with normal ears were collected to be the control group. The shape of OEAC was categorized into 5 groups according to Mahboubi's classification, and the dimension of each patient's OEAC was measured at 2 defined sections (annular section and isthmus/midcanal section). The most prevalent shape of OEAC for the lesion sides of the ears was cylindrical, followed by conical, and hourglass in both the COM and the control groups. As to the dimension of OEAC, there were no significant differences between lesion ears and normal ears among patients in the COM group as well as between lesion ears in the COM group and normal ears in the control group. We concluded that the bony dimension of the external ear canal was not related to COM. This suggested that chronic inflammation or infection of middle ear may not cause bony thickening of OEAC, despite the kind of OEAC shape involved.
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Affiliation(s)
- Yi-Fang Lee
- Department of Otolaryngology-Head and Neck Surgery, 46615Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University, Taipei
| | - Pei-Yin Wei
- Department of Otolaryngology-Head and Neck Surgery, 46615Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University, Taipei
| | - Chia-Huei Chu
- Department of Otolaryngology-Head and Neck Surgery, 46615Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University, Taipei
| | - Wen-Huei Liao
- Department of Otolaryngology-Head and Neck Surgery, 46615Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University, Taipei
| | - An-Suey Shiao
- Department of Otolaryngology-Head and Neck Surgery, 46615Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University, Taipei
| | - Mao-Che Wang
- Department of Otolaryngology-Head and Neck Surgery, 46615Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University, Taipei
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Surgical treatment of chronic ear disease in remote or resource-constrained environments. The Journal of Laryngology & Otology 2018; 133:49-58. [DOI: 10.1017/s0022215118002165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackgroundSurgery for chronic suppurative otitis media performed in low- and middle-income countries creates specific challenges. This paper describes the equipment and a variety of techniques that we find best suited to these conditions. These have been used over many years in remote areas of Nepal.Results and conclusionExtensive chronic suppurative otitis media is frequently encountered, with limited pre-operative investigation or treatment possible. Techniques learnt in better-resourced settings with good follow up need to be modified. The paper describes surgical methods suitable for resource-poor conditions, with rationales. These include methods of tympanoplasty for subtotal wet perforations, hearing reconstruction in wet ears and open cavities, large aural polyps, and canal wall down mastoidectomy with cavity obliteration. Various types of autologous ossiculoplasty are described in detail for use in the absence of prostheses. The following topics are discussed: decision-making for surgery on wet or best hearing ears, children, bilateral surgery, working with local anaesthesia, and obtaining adequate consent in this environment.
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Schwarz D, Luers JC, Huttenbrink KB, Stuermer KJ. Acquired stenosis of the external auditory canal - long-term results and patient satisfaction. Acta Otolaryngol 2018; 138:790-794. [PMID: 29852809 DOI: 10.1080/00016489.2018.1476779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND The surgical treatment of acquired post-inflammatory atresia of the external auditory canal (EAC) is challenging. Based on the long-term surgical experience, a modified split skin graft technique has been established at our clinic. AIMS/OBJECTIVES The aim was to evaluate the clinical and audiological data and patient satisfaction after performing meatoplasty. MATERIAL AND METHODS In total, 16 patients were included who underwent intraoperative enlargement of the bony EAC, resection of the fibrotic scar tissue, reconstruction with split skin grafts and splinting of the anterior tympanomeatal angle in the period of 2004-2016. Patients presented at a long-term follow-up appointment for reevaluation. RESULTS The mean follow-up time was 52 months after surgery. The pure-tone average (52 dB vs. 31 dB) and the air-bone gap (27 dB vs. 11 dB) decreased significantly compared to the preoperative status. The grade of stenosis also showed a significant improvement during the follow-up visit. Complete re-atresia was observed only in two patients (10.5%). CONCLUSION The applied surgical technique is a safe and successful treatment option for acquired atresia of the EAC. SIGNIFICANCE The study provides important data for the surgical treatment of acquired atresia of the EAC and corroborates the significance of intensive aftercare.
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Affiliation(s)
- David Schwarz
- Department of Otorhinolaryngology, Medical Faculty, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - Jan Christoffer Luers
- Department of Otorhinolaryngology, Medical Faculty, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - Karl Bernd Huttenbrink
- Department of Otorhinolaryngology, Medical Faculty, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - Konrad Johannes Stuermer
- Department of Otorhinolaryngology, Medical Faculty, Head and Neck Surgery, University of Cologne, Cologne, Germany
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Jotdar A, Dutta M, Kundu S, Mukhopadhyay S. Advancing Cholesteatoma Secondary to Acquired Atresia of the External Auditory Canal: Clinical Perspectives. J Clin Diagn Res 2017; 11:MD01-MD03. [PMID: 28969167 DOI: 10.7860/jcdr/2017/29458.10385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 05/29/2017] [Indexed: 11/24/2022]
Abstract
Acquired atresia of External Auditory Canal (EAC) is seldom encountered in routine otolaryngology practice. Apart from resulting in moderate-to-severe conductive hearing impairment, it is a potentially dreaded condition which might lead to canal cholesteatoma. Suspected to develop as a consequence of a pre-existing chronic otitis externa/media, the EAC atresia leads to proximal (medial) accumulation of desquamated epithelium and denatured keratin (the canal cholesteatoma) that further leads to aggravation of the chronic otitis, thereby initiating a vicious cycle. The canal cholesteatoma might progress unhindered into the middle ear and mastoid cavity, with its characteristic bone-eroding property, producing complications. A high index of clinical suspicion along with proper imaging are therefore essential to apprehend the disease progression in a patient presenting with an apparently innocuous EAC stenosis/atresia. In this report, we illustrate the clinical details of a young girl with unilateral acquired EAC atresia where canal cholesteatoma had turned extensive, invaded the middle ear cleft, and produced a post-aural fistula, thereby establishing one of the extreme outcomes of chronic otitis.
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Affiliation(s)
- Arijit Jotdar
- Senior Resident, Department of Otorhinolaryngology and Head-Neck Surgery, Nil Ratan Sircar Medical College and Hospital, Sealdah, Raja Bazar, Kolkata, West Bengal, India
| | - Mainak Dutta
- Resident Medical Officer-cum-Clinical Tutor, Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, College Street Kolkata, Kolkata, West Bengal, India
| | - Sohag Kundu
- Resident Medical Officer-cum-Clinical Tutor, Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, College Street Kolkata, Kolkata, West Bengal, India
| | - Subrata Mukhopadhyay
- Professor, Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, College Street Kolkata, Kolkata, West Bengal, India
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Acquired External Auditory Canal Atresia: A Comparison of Acellular Dermal Matrix and Split-thickness Skin Grafting Techniques. Otol Neurotol 2017; 38:1149-1152. [DOI: 10.1097/mao.0000000000001487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Kondratchikov DS, Diab KM, Korvyakov VS, Terekhina LI. [Acquired atresia and stenosis of the external acoustic meatus]. Vestn Otorinolaringol 2017. [PMID: 28631687 DOI: 10.17116/otorino201782369-74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Acquired atresia of the external acoustic meatus is a rare pathological condition characterized by obliteration of the medial part of the external acoustic canal by a soft fibrous plug. The present article presents an overview of a series of cases of acquired atresia and stenosis of the external acoustic meatus with the description of etiology, pathogenesis, and methods for the treatment of this condition. In the majority of the cases, atresia develops at the final stage of granulation external otitis with or without an accompanying dermatological pathology. Another common cause of the acquired atresia of the external acoustic meatus is the fracture of the temporal bone as well as extensive ear surgery, radiation therapy and a neoplasm in the auditory passage. The surgical strategy for the management of the acquired atresia and stenosis of the external acoustic meatus consists, besides the excision of the fibrous plug, of the application of the cutaneous flaps and/or transplants to cover the bare parts of the bone portion of the affected external canal. In spite of such treatment, the state of the external acoustic canal remains unstable, and a relapse of its atresia and stenosis can not be wholly excluded.
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Affiliation(s)
- D S Kondratchikov
- Research and Clinical Centre of Otorhinolaryngology, Federal Medico-Biological Agency, Moscow, Russia, 123182
| | - Kh M Diab
- Research and Clinical Centre of Otorhinolaryngology, Federal Medico-Biological Agency, Moscow, Russia, 123182
| | - V S Korvyakov
- Research and Clinical Centre of Otorhinolaryngology, Federal Medico-Biological Agency, Moscow, Russia, 123182
| | - L I Terekhina
- Research and Clinical Centre of Otorhinolaryngology, Federal Medico-Biological Agency, Moscow, Russia, 123182
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Droessaert V, Vanspauwen R, Offeciers E, Zarowski A, Dinther JV, Somers T. Surgical Treatment of Acquired Atresia of the External Auditory Ear Canal. Int Arch Otorhinolaryngol 2017; 21:343-346. [PMID: 29018496 PMCID: PMC5629087 DOI: 10.1055/s-0037-1598604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 11/06/2016] [Indexed: 11/16/2022] Open
Abstract
Introduction
Acquired atresia of the external auditory canal is characterized by the formation of fibrous tissue in the medial part. The causes include chronic otitis externa, perforated chronic otitis media, postoperative or idiopathic healing problems. Acquired atresia presents with hearing loss and can be associated with otorrhea.
Objective
We analyzed the results of surgery after six months and two years by checking (1) pre- and postoperative hearing thresholds; (2) presence of otorrhea; and (3) whether a dry and patent ear canal is achieved.
Methods
We conducted this retrospective study at a tertiary referral center. In total, 27 ears underwent treatment with resection of the fibrotic plug followed by transplantation of a split-thickness skin graft covering the bare bone and tympanic membrane. When necessary, we combined this with a myringoplasty and a (meato-) canalplasty.
Results
Otorrhea was present in 59.3% of the patients initially and in 14.8% at six months and 11% at two years postoperative. A dry and patent ear canal was obtained in 55.6% after six months and in 89% of the patients after two years (
n
= 27). The pure tone average before surgery was 39.1 dBHL (SD = 20 dBHL), at six months 31.4 dBHL (SD = 16.4 dBHL), and at 24 months postop 30.9 dBHL (SD = 17.1 dBHL). We observed a statistically significant improvement of hearing in 63% of the patients at six months (
p
= 0.005) and in 65% after two years (
p
= 0.022).
Conclusions
Treatment of acquired atresia remains a challenge. Using the appropriate surgical technique, including skin-grafting and regular postoperative check-up, rendered excellent results regarding otorrhea and a moderate improvement of hearing was achieved in 65% of the patients after two years.
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Affiliation(s)
- Valerie Droessaert
- Department of ENT, European Institute for ORL, Wilrijk, Antwerp, Belgium
| | - Robby Vanspauwen
- Department of ENT, European Institute for ORL, Wilrijk, Antwerp, Belgium
| | - Erwin Offeciers
- Department of ENT, European Institute for ORL, Wilrijk, Antwerp, Belgium
| | - Andrzej Zarowski
- Department of ENT, European Institute for ORL, Wilrijk, Antwerp, Belgium
| | - Joost van Dinther
- Department of ENT, European Institute for ORL, Wilrijk, Antwerp, Belgium
| | - Thomas Somers
- Department of ENT, European Institute for ORL, Wilrijk, Antwerp, Belgium
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Abstract
BACKGROUND The auricles are easily injured or amputated in case of head trauma. Inadequate treatment of the external auditory canal (EAC) after auricular injury is often seen and can lead to significant complications of the EAC. CASE REPORT The authors report 4 cases of auricular injury or amputations. In all patients inadequate first treatment led to stenosis of the EAC. Three patients required recanalization of the EAC because of hearing loss and the risk of further complications. CONCLUSION Treatment of auricular injury should consist of (pre-emptive) packing of the EAC with antibiotic gauzes followed by thorough examination of the EAC to prevent canal stenosis and subsequent complications.
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Loos E, Verhaert N, Willaert A, Devriendt K, Swillen A, Hermans R, Op de Beeck K, Hens G. Malformations of the middle and inner ear on CT imaging in 22q11 deletion syndrome. Am J Med Genet A 2016; 170:2975-2983. [DOI: 10.1002/ajmg.a.37872] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/08/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Elke Loos
- Department of Otorhinolaryngology-Head and Neck Surgery; University Hospitals Leuven; Leuven Belgium
| | - Nicolas Verhaert
- Department of Otorhinolaryngology-Head and Neck Surgery; University Hospitals Leuven; Leuven Belgium
- Department of Neurosciences, ExpORL, KU Leuven; University of Leuven; Leuven Belgium
| | - Annelore Willaert
- Department of Otorhinolaryngology-Head and Neck Surgery; University Hospitals Leuven; Leuven Belgium
| | | | - Ann Swillen
- Centre for Human Genetics; University Hospitals Leuven; Leuven Belgium
| | - Robert Hermans
- Department of Radiology; University Hospitals Leuven; Leuven Belgium
| | - Katya Op de Beeck
- Department of Radiology; University Hospitals Leuven; Leuven Belgium
| | - Greet Hens
- Department of Otorhinolaryngology-Head and Neck Surgery; University Hospitals Leuven; Leuven Belgium
- Department of Neurosciences, ExpORL, KU Leuven; University of Leuven; Leuven Belgium
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Ribeiro A, Leonardo A, Rodrigues MRE, Lopes G. Split Thickness Skin Grafts in Four Cases of Medial Meatal Fibrosis of the External Auditory Canal. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015. [DOI: 10.1016/j.otoeng.2014.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Split thickness skin grafts in four cases of medial meatal fibrosis of the external auditory canal. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015; 66:281-5. [PMID: 26051080 DOI: 10.1016/j.otorri.2014.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/20/2014] [Accepted: 07/16/2014] [Indexed: 11/22/2022]
Abstract
Medial meatal fibrosis is a rare condition in which the medial portion of the external auditory canal is obliterated with fibrous tissue. We selected 4 cases of patients with medial meatal fibrosis with a history of recurrent otorrhea who underwent surgery during the years of 2012 and 2013, presenting the surgical results here. Physical examination showed an obliterated external auditory canal and conductive hypoacusis. All cases were solved using a split thickness skin graft from the thigh. The surgical principles that appear to correlate with a favorable outcome are the removal of all fibrous tissue and unhealthy skin, a wide canaloplasty and the use of a split thickness skin graft.
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21
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Amita RN, Sandhyamani S, Unnikrishnan M. Extensive unilateral tuberculosis lung with segmental atresia of principal bronchus. Lung India 2014; 31:311. [PMID: 25125833 PMCID: PMC4129618 DOI: 10.4103/0970-2113.135800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Radhakrishnan Nair Amita
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Samavedam Sandhyamani
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Madathipat Unnikrishnan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India. E-mail:
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23
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Sosulski AB, Hayes JD. Cicatricial external auditory canal stenosis caused by ectodermal dysplasia: Rapp-Hodgkin syndrome. EAR, NOSE & THROAT JOURNAL 2014; 92:E24. [PMID: 23780599 DOI: 10.1177/014556131309200617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We present a case of recurrent cicatricial stenosis of the external ear canals caused by ectodermal dysplasia, specifically Rapp-Hodgkin syndrome, in a 45-year-old woman. No form of medical or surgical management has produced durable patency of the patient's ear canals, and her hearing loss is being managed with hearing aids. Topical management of the recurring external otitis slows the process but has been unsuccessful in preventing restenosis of both external auditory canals.
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Affiliation(s)
- Amanda B Sosulski
- Department of Surgery, Winthrop-University Hospital, Mineola, NY, USA
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24
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Morimoto C, Nishimura T, Hosoi H, Saito O, Fukuda F, Shimokura R, Yamanaka T. Sound transmission by cartilage conduction in ear with fibrotic aural atresia. ACTA ACUST UNITED AC 2014; 51:325-32. [DOI: 10.1682/jrrd.2013.05.0128] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 09/18/2013] [Indexed: 11/05/2022]
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Postinflammatory medial meatal fibrosis: early and late surgical outcomes. The Journal of Laryngology & Otology 2013; 127:1160-8. [DOI: 10.1017/s002221511300248x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectives:To evaluate the primary and long-term surgical outcomes of patients with postinflammatory medial meatal fibrosis.Methods:A retrospective study was conducted of 14 ears (in 12 patients) with postinflammatory medial meatal fibrosis managed surgically. Outcome measures were primary (i.e. less than six months) and long-term (i.e. greater than five years) closure of the air–bone gap, and the incidence of otorrhoea and restenosis.Results:At primary review, the mean air–bone gap ± standard deviation had decreased from 29.9 ± 11.6 dB to 12 ± 8.4 dB (p < 0.0006). Seven (50 per cent) ears had closure of the air–bone gap to within 10 dB. However, for the 9 ears receiving long-term review, the mean air–bone gap ± standard deviation increased to 19.3 ± 15.2 dB; there was no significant difference between this result and pre-operative values (p = 0.06). Of the 9 long-term review ears, 3 (33 per cent) showed closure of the air–bone gap to within 10 dB. Recurrent otorrhoea was the most common complication, occurring in 5 of the 9 long-term review ears (56 per cent); in addition, 3 (33 per cent) of these 9 ears developed restenosis.Conclusion:Over time, the success of surgery for postinflammatory medial meatal fibrosis diminishes. This was demonstrated in the present study by progressive post-operative hearing decline and a high prevalence of otorrhoea and restenosis.
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Kuczkowski J, Sierszeń W, Narożny W, Gulida G. [Surgical treatment results of acquired external auditory canal atresia]. Otolaryngol Pol 2012. [PMID: 23200558 DOI: 10.1016/j.otpol.2012.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Acquired post inflammatory external auditory canal atresia is a rear complication of external ear disease. It is presented as a connective tissue scar in bony part of external auditory canal. The aim of this study is clinical and epidemiological analysis and presentation of diagnostics and treatment results of patients with atresia treated in the Otolaryngology Department of Medical University of Gdansk. MATERIAL AND METHODS In the period of 3 years (2008-11) 10 patients (8 women and 2 men) aged 30 to 70-years-old (medium 53 years) were treated for acquired atresia. All of these patients had medial closure of EAC with thick connective tissue scar and tympanic membrane involvement. Intrameatal access was performed in 5 patients, intraural access in 3 patients and retroaurical access in 2 patients. In all cases canaloplasty with meato-tympanic angle enlargement was performed, skin defect was replaced with free epidermal flap, silicon foil with fibrinous sponge was used for coverage. RESULTS In all of our patients external auditory canal widening and hearing improvement was achieved. Due to increasing EAC narrowing four patients underwent second surgery with another free epidermal flap grafting. CONCLUSION The selection of surgical access in patients with acquired atresia should comply with the etiology of the disease and the shape of EAC. During surgery we aim at maximal broadening of the bony part of EAC. The success of the treatment depends on meato-tympanic angle enlargement and free epidermal flap grafting.
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Affiliation(s)
- Jerzy Kuczkowski
- Katedra i Klinika Otolaryngologii Gdańskiego Uniwersytetu Medycznego, Poland.
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27
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Outcomes of canalplasty for chronic obliterative otitis externa. The Journal of Laryngology & Otology 2012; 126:1016-21. [DOI: 10.1017/s0022215112001703] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroduction:Chronic obliterative otitis externa is a rare cause of conductive hearing loss, characterised by stenosis of the deep ear canal secondary to chronic inflammation. A multitude of canalplasty techniques have been described, with variable success.Method:Fourteen patients undergoing canalplasty performed by the senior author for refractory obliterative otitis externa, over an 8-year period, were included in the study. All underwent split-skin grafting of the denuded canal and meticulous post-operative aural care. Outcome measures included the Glasgow Benefit Inventory and pure tone audiology.Results:At 3 months post-operatively, the four-tone average threshold had improved by a mean of 13.9 dB (95 per cent confidence interval –9.9 to 37.8 dB; t < 0.001) in the operated ear. The mean Glasgow Benefit Inventory score was 20 (95 per cent confidence interval −2.3 to 42.1).Conclusion:Significant improvements in both hearing and quality of life are achievable in patients with end-stage obliterative otitis externa treated surgically. Highly trained and competent aural care practitioners are a prerequisite for the success of the procedure, and a substantial number of patients must be prepared to submit to long-term follow-up care.
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28
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External auditory canal reconstruction following subtotal auricular resection with a tragal lobule wrap flap. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-012-0727-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mehdi B, Codreanu CM, Hautefort C, Tran Ba Huy P. [How to manage acquired stenosis of the external auditory canal]. ANNALES D'OTO-LARYNGOLOGIE ET DE CHIRURGIE CERVICO FACIALE : BULLETIN DE LA SOCIETE D'OTO-LARYNGOLOGIE DES HOPITAUX DE PARIS 2009; 126:278-282. [PMID: 19875098 DOI: 10.1016/j.aorl.2009.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 09/25/2009] [Indexed: 05/28/2023]
Affiliation(s)
- B Mehdi
- Hôpital Farhat Hached, Sousse, Tunisie, France
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30
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Magliulo G. Acquired Atresia of the External Auditory Canal: Recurrence and Long-Term Results. Ann Otol Rhinol Laryngol 2009; 118:345-9. [DOI: 10.1177/000348940911800505] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: I describe the clinical symptoms and signs of acquired atresia of the external auditory canal (EAC) and the technique used to manage it. Methods: Forty-one consecutive patients affected by acquired atresia of the EAC were assessed by otoscopy, pure tone audiometry, computed tomography, and traditional and echo-planar diffusion-weighted magnetic resonance imaging. The anatomic and functional hearing results were evaluated. Results: At surgery for acquired atresia of the EAC, an EAC cholesteatoma was found in 3 of the 41 patients. Twenty-three of the 41 patients were followed for at least 5 years. Recurrence was seen in 9 of the 25 ears (36%) over the entire period of observation. Twenty-one, 23, and 22 of the patients had a normal or nearly normal contour and size of the ear canal at 6 months, 1 year, and 5 years, respectively. The results were similar for the air-bone gap. Conclusions: The main complication following surgery was recurrence. There was recurrence at 6 months in 4 patients (16%). Recurrence was seen in 12% of the cases at the 5-year follow-up. Similar findings were clear on evaluation of the hearing results. This result demonstrates that the surgical procedure, even when performed correctly, did not afford a stable, long-lasting outcome in a cohort of patients.
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KATO KATSUTOMO, SHINODA KENICHI, KITAGAWA YOSHIKAZU, MANABE YOSHITAKA, OYAMADA JOICHI, IGAWA KAZUNARI, VIDAL HILD, ROKUTANDA ATSUSHI. A possible case of prophylactic supra-inion trepanation in a child cranium with an auditory deformity (pre-Columbian Ancon site, Peru). ANTHROPOL SCI 2007. [DOI: 10.1537/ase.061126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- KATSUTOMO KATO
- Department of Physical Therapy, Health Sciences, Nagasaki University Graduate School of Biomedical Science
| | - KEN-ICHI SHINODA
- Department of Anthropology, National Museum of Nature and Science, Tokyo
| | - YOSHIKAZU KITAGAWA
- Department of Oral Anatomy and Dental Anthropology, Medical and Dental Science, Nagasaki University Graduate School of Biomedical Science
| | - YOSHITAKA MANABE
- Department of Oral Anatomy and Dental Anthropology, Medical and Dental Science, Nagasaki University Graduate School of Biomedical Science
| | - JOICHI OYAMADA
- Department of Oral Anatomy and Dental Anthropology, Medical and Dental Science, Nagasaki University Graduate School of Biomedical Science
| | - KAZUNARI IGAWA
- Department of Oral Anatomy and Dental Anthropology, Medical and Dental Science, Nagasaki University Graduate School of Biomedical Science
| | - HILD VIDAL
- Division of Anthropology, National Museum of Archaeology, Anthropology and History of Peru, Lima
| | - ATSUSHI ROKUTANDA
- Department of Oral Anatomy and Dental Anthropology, Medical and Dental Science, Nagasaki University Graduate School of Biomedical Science
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