Blind sac closure of the external auditory canal for chronic middle ear disease

Quality of Life After Modified Rambo Ear Canal Closure in Pediatric and Adult Patients

OBJECTIVE

To present the surgical and quality of life (QOL) outcomes of patients who underwent blind sac closure of the external auditory canal (EAC) via a modified Rambo approach.

STUDY DESIGN

Retrospective case review.

SETTING

Tertiary academic referral center.

METHODS

All patients who underwent EAC closure with a modified Rambo approach between 2015 and 2021 were evaluated. Complication rates, QOL estimations from a validated survey, and subjective cosmetic reports were analyzed.

RESULTS

Thirty-five ears were closed in 31 patients. The most common indication for surgery was related to cochlear implantation and cochlear malformation or cholesteatoma (31.4%). No case involved an immediate complication requiring revision surgery, and 4 ears (11.4%) were suspected of having cholesteatoma within the surgical cavity at a mean 28.6-month follow-up. Adults (≥18 years) had significantly higher QOL scores than children in the medical resource subscale of the Chronic Ear Survey (P < .01), and patients undergoing concurrent EAC closure and skull base tumor removal scored higher than others (P = .04). Females reported higher cosmetic scores than males (P = .04). QOL and cosmetic scores compared favorably to previously published data involving the management of otologic disease.

CONCLUSIONS

Ear canal closure can be a useful technique for select adult and pediatric patients. Patient and surgeon concerns regarding QOL and cosmesis in ear canal closure should be explored prior to employing this surgical technique, though the present data suggest that the modified Rambo approach to closure is generally associated with reasonable outcomes in both areas.

Long-Term Outcomes from Blind Sac Closure of the External Auditory Canal: Our Institutional Experience in Different Pathologies

OBJECTIVES

This study reports long-term results of blind sac closure of the external auditory canal performed for various pathologies, compares the complication rates and the need for revision surgery.

MATERIALS AND METHODS

This study is a retrospective review. Ninety-six cases of blind sac closure performed for various pathologies were included in this study. The primary pathologies included extensive mucosal disease in an open mastoid cavity, cholesteatoma, skull base lesion, cerebrospinal fluid leak, and osteoradionecrosis of the temporal bone. Preoperative history, postoperative complications, and the need for revision surgery were evaluated.

RESULTS

The most common indication for blind sac closure in our series involved skull base lesions (62.5%). The mean follow-up period was 46 months (4 months - 20 years). The total complication rate related to blind sac closure was 10.4%. The median time between surgery and long-term complications was 5.5 years. Patients with chronic mucosal disease had the highest rate of complications.

CONCLUSION

Blind sac closure of external meatus can be effectively performed for different pathologies. Long-term follow-up with patients is necessary. Patients with chronic mucosal disease have the highest complication rates.

Preauricular Approach for Cholesteatoma Resection After Surgical Overclosure of the External Auditory Canal and Cochlear Implantation

: Chronic suppurative otitis media can have long-term effects on hearing if not managed effectively. When combined with cholesteatoma the condition may require creation of an open mastoid cavity. Recurrence of cholesteatoma is a concern when cochlear implantation is performed with overclosure of the external auditory meatus. A 61-year-old female with recurrent cholesteatoma in this setting was treated using a preauricular approach to provide adequate visualization while preventing the need to remove the implant or risking injury to the internal components. This technique would be useful in similar patients to prevent morbidity from removal and reinsertion of a cochlear implant.