New strategies and methods for reconstruction of the outer ear canal (OEC)

Innovated surgery incision for patients of congenital malformation of the middle and outer ear with infection (CMMOEI)

BACKGROUND

It is the challenging clinical issue of combining debridement of infected lesions and retaining the blood skin flap for auricle reconstruction in patients of Congenital Malformation of the Middle and Outer Ear with Infection (CMMOEI).

AIMS/OBJECTIVES

To innovate and introduce an surgery incision to solve the challenging clinical issue of a combined debridement of infection yet retaining a well vascularized skin flap for auricle reconstruction in patients with CMMOEI.

MATERIAL AND METHODS

A combined innovated incision of ear sulcus and prefabricated earlobe was used for 23 cases (23 ears) with CMMOEI, The success in the management of the encountered infections, and the short and moderate-term outcome of the innovated incision to preserve a well-vascularized skin flap for subsequent auricle reconstruction were reviewed. The 23 cases include 10 males and 13 females, aged 4-14 years (mean 8.4 years), 7 left ears and 16 right ears. 14 ears stenosis and 9 ears atresia of the outer ear canals.

RESULTS

In all 23 cases, the infections were successfully cleared without recurrence or complication with 2-year follow-up. The local skin flap and its blood supply were well preserved for subsequent auricle reconstruction.

CONCLUSIONS AND SIGNIFICANCE

The new incision can facilitate clearance of infection in CMOMEI patients, and preserve the retroauricular tissues for subsequent harvesting of a well-vascularized skin flap for subsequent auricle reconstruction.

Relationship between congenital malformation of the outer ear and hearing

Background: There is no report on the relationship between congenital malformation of the outer ear and hearing, which makes it possible to predict the hearing level just based on microtia grades.Aims/Objectives: To investigate the correlation between two types of congenital malformation of the outer ear [microtia and Outer Ear Canal Malformation (OECM)] and hearing, as well as the interrelationship among all three variables.Material and methods: A total of 535 cases (598 ears) of congenital malformation of the middle and outer ear (CMMOE) with hearing data, out of which 319 cases (349 ears) microtia with available images and graded by I-V, 449 cases (482 ears) OECM graded by atresia, stenosis and normal, and 87 cases (87 ears) OEC atresia graded I-IV, 301 cases (301 ears) with materials of microtia, OECM and hearing at the same time were carried out correlation analysis. The Average Air-Conduction Threshold of pure tone (AACT) at 0.5-4 KHz was calculated corresponding to the ears with different malformation grades. The differences in AACT among different malformation grades, the correlation between malformation severity and AACT, as well as the relationship among microtia, OECM and AACT were analyzed. The one-way analysis of variance (ANOVA) was employed to compare the differences in AACT, Kendall's tau-b rank correlation coefficient test was used for correlation analysis. A statistical significance level of p < 0 .05 was applied.Results: Among the 349 ears with microtia, the corresponding AACT values for grades I to V were 61.6, 63.0, 69.9, 75.4, and 75.0 (dB HL), respectively. Comparing grade III to grades II or IV, both p < 0 .05. However, p > 0 .05 between grade I and II or between grade IV and V. The correlation coefficient between microtia grades and AACT r = 0.219, p < 0.05. Among the 482 ears of OECM, the distribution was as follows: 73.6% atresia, 19.1% stenosis, and 7.3% normal, the corresponding AACT values were 64.1, 61.7, and 52.5 (dB HL), respectively. Comparing normal to stenosis or atresia, both p < 0.05, while between atresia and stenosis p > 0.05. The correlation between OECM and AACT was r = 0.104, p < 0.05. The AACT values corresponding to grades I to IV of OEC atresia in the 87 ears were 59.9, 65.1, 71.1, and 64.1 (dB HL), respectively. Comparing these grades, all p > 0.05. The correlation between the degree of atresia and AACT r = 0.23, p < 0 .05. The correlation coefficients for 301 ears microtia to OECM, microtia to AACT, OECM to AACT were r = 0.339, r = 0.163 and r = 0.128 respectively, with all p < 0 .05.Conclusion and significance: There are positive correlations among the degree of microtia, degree of OECM, and AACT values for each other, and so between the degree of OEC atresia and AACT, suggesting that as the severity of microtia or OECM increased, the AACT also tended to be higher, which make it possible to predict the hearing level and the degree of OECM based on microtia grades in clinical practice. Additionally, there are significant differences in AACT values in microtia grade III to grades II or IV, OEC normal to stenosis or atresia, while no differences in microtia grade I to II and grade IV to V, OEC stenosis to atresia, and among the grades I-IV of the OEC atresia.

Pure tone audiometry is a new method for evaluating congenital malformation of the middle and outer ear (CMMOE)

Background: The preoperative evaluation of Congenital Malformation of the Middle and Outer Ear (CMMOE) is very important. Jahrsdoerfer score commonly used at present, based on CT scanning images of the temporal bone, is often unable to accurately evaluate deformity and hearing level.Aims/Objectives: To investigate and promote a straightforward and easily accessible assessment method, pure tone audiometry, for the evaluation of CMMOE.Material and Methods: A total of 223 cases (244 ears) CMMOE with hearing data were retrospectively analyzed. Among them, 180 cases (197 ears) underwent exploratory tympanoplasty with clear conditions: ossicle numbers in 136 cases (147 ears) and morphology in 128 cases (138 ears) and vestibular window development in 137 cases (146 ears), and CT scans of temporal bone in 113 cases (120 ears). 1). The correlation was analyzed between ossicle numbers, ossicle morphology, Jahrsdoerfer score groups and their corresponding Average Air-Conduction Threshold of pure tone (AACT) at 0.5-4 KHz. 2) The AACT difference is compared among the above groups respectively and between the developed and undeveloped groups of vestibular window at 0.5-4 KHz and each frequency of 0.125-8 KHz. Spearman method was used for correlation analysis (calculating coefficient r and p values). For the data followed a normal distribution, a one-way analysis of variance (ANOVA) and t-test were employed, otherwise, Kruskal Wallis multiple local rank coincidence test and Wilcoxon rank sum test were used. p <0 .05 was considered statistically significant.Results: 1) The correlation coefficients between the groups of ossicle number scores, ossicle morphology scores, Jahrsdoerfer scores and their corresponding AACT are r = -0.187 (p <0 .05), r = -0.073 (p >0 .05) and r = -0.079 (p > 0.05), respectively. 2) Comparison of AACT difference based on ossicle number or morphological scores and Jahrsdoerfer scores with p > 0.05 among all groups, respectively. The AACT difference between the developed and undeveloped vestibular window groups is 5.5 (63.5/69.0) dB HL(p < .05) at 0.5-4KHz, out of 0.125-8 KHz frequency 1, 2, 4 KHz were 5.7 (65.0/70.7) dB HL, 8.4 (60.7/69.1) dB HL and 2 (61.5/63.5) dB HL, respectively, all p < 0.05, the other frequencies with all p > 0.05.Conclusions and Significance: 1) Ossicle number was correlated with AACT, but not for ossicle morphology and Jahrsdoerfer scores. 2) There was no significant difference in AACT corresponding to ossicle number or morphology scores and Jahrsdoerfer scores groups, but the patients with undeveloped vestibular window had poorer hearing than those with developed ones. Therefore, the AACT can evaluate the development of ossicle and vestibular window, and more directly reflect the hearing level than Jahrsdoerfer score. Pure tone audiometry is simple, widely used, and easily accessible, which making it a new assessment method of CMMOE.

Congenital ear malformation (CEM)

BACKGROUND

At present, there are not international unified standards and reports on Congenital Ear Malformation (CEM) in the world, which makes it difficult to transfer information and compare the literature.

AIMS/OBJECTIVES

Through the statistical analysis of a large sample of CEM, a unified standard of all aspects of CEM is proposed and the data are provided for reference, which is convenient for the international work and literature comparison in this field.

MATERIALS AND METHODS

Based on the author's 30 years of clinical and scientific research work on CEM and the relevant cases of 3231 (4714 ears) in our hospital, and combined with literature, statistical analysis was made.

RESULTS

This paper summarizes the classification, definition, epidemiology, embryonic development, pathogenic factors of CEM and elaborates on the clinical manifestations, examination and sequence therapy of representative Congenital Malformation of the Middle and Outer Ear (CMMOE). We also introduce malformation of the auricle and inner ear, so as to cover the outer, middle and inner ear. At the same time, we introduce our achievements and contributions in this field.

CONCLUSIONS AND SIGNIFICANCE

This study provides reference to the international unified standard and treatment principle of the CEM.