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Alkheder A, Alhiraki I, Alahmad M, Alshami FO, Jamal L, Yousfan A. The effective surgical management of traumatic external auditory canal atresia resulting from a dog bite using a stent silicone prosthesis. Int J Surg Case Rep 2024; 117:109540. [PMID: 38493613 PMCID: PMC10958055 DOI: 10.1016/j.ijscr.2024.109540] [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: 02/21/2024] [Revised: 03/09/2024] [Accepted: 03/13/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION Acquired external auditory canal (EAC) atresia is a very rare condition, especially due to direct trauma. The challenge lies in the difficulty of treatment and the tendency to recur even after a long period. Here we present a case report of treatment of recurrent EAC atresia resulting from a dog bite using a silicone stent prosthesis. CASE PRESENTATION A 4-year-old, bitten by a dog, suffered severe head injuries, including scalp avulsion and left auricle avulsion. Initial treatment included wound closure, antibiotics, and vaccines. However, complications arose, leading to left EAC atresia and hearing loss. Surgical interventions, including canaloplasty and skin grafting, were conducted, with recurrence prompting second surgery with using a silicon prosthetic post-surgery. Follow-up for up to 14 months showed no evidence of recurrence of atresia, with complete improvement in hearing. DISCUSSION Acquired stenosis of the External Auditory Canal (EAC) can result from various factors, predominantly otitis externa and traumatic incidents, including previous surgeries. Though direct trauma is rare, it can lead to stenosis. Surgical intervention is often necessary for post-traumatic cases, involving removal of obstructions, canal widening, and reconstruction. Management depends on maturity of stenosis, with non-surgical methods for soft stenoses and surgical procedures for mature ones, often supplemented by postoperative stents to preventing restenosis. CONCLUSION Acquired external auditory canal atresia remains a rare, difficult-to-treat entity with a high rate of recurrence. The use of a silicone prosthesis stent after surgery can be considered an effective method in preventing recurrence.
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Affiliation(s)
- Ahmad Alkheder
- Department of Otorhinolaryngology, Al Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria; Faculty of Medicine, Syrian Private University, Damascus, Syria.
| | - Ismail Alhiraki
- Department of Otorhinolaryngology, Al Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria; Department of Otorhinolaryngology, Doha Clinic Hospital, Ministry of Public Health, Doha, Qatar
| | - Molham Alahmad
- Department of Otorhinolaryngology, Al Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Fadi Osama Alshami
- Department of Otorhinolaryngology, Al Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Lubna Jamal
- Department of Otorhinolaryngology, Al Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Abdulmajeed Yousfan
- Department of Otorhinolaryngology, Al Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
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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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Transplantation of autologous oral mucosal epithelial cell sheets inhibits the development of acquired external auditory canal atresia in a rabbit model. Acta Biomater 2020; 110:141-152. [PMID: 32438108 DOI: 10.1016/j.actbio.2020.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 11/23/2022]
Abstract
Acquired external auditory canal atresia is characterized by fibrous tissue formation in the ear canal, hearing loss and chronic otorrhea. Although the disease can be treated surgically, the recurrence rate is high. This study explored whether autologous oral mucosal epithelial cell sheets could be used as a novel therapy for ear canal atresia. We succeeded in generating a rabbit model of acquired external auditory canal atresia by dissecting the skin of the ear canal. Endoscopic and histological findings in this model indicated that atresia developed over a 4-week period and was not inhibited by the placement of polyglycolic acid sheets immediately after skin dissection. By contrast, transplantation of autologous oral mucosal epithelial cell sheets, which had been fabricated by culture on temperature-responsive inserts without a feeder layer, prevented the development of atresia during the 4-week period after skin dissection. Transplantation of autologous epithelial cell sheets after surgical treatment of acquired external auditory canal atresia could be a promising new method to reduce the risk of disease recurrence. STATEMENT OF SIGNIFICANCE: Acquired external auditory canal atresia is characterized by fibrous tissue formation in the ear canal, which leads to hearing loss and chronic otorrhea. Although surgical treatments are available, the recurrence rate is high. In this study, we successfully generated a rabbit model of acquired external auditory canal atresia by dissecting the skin of the ear canal. Furthermore, we utilized this new animal model to investigate whether the transplantation of autologous oral mucosal epithelial cell sheets could be used as a novel therapy for ear canal atresia. Our results raise the possibility that the transplantation of autologous epithelial cell sheets after surgical treatment of ear canal atresia could be a promising new method to reduce the risk of disease recurrence.
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Zhang K, Qu P, Wang B, Zhang E, Chen B. Management of the Temporal Bone Fibrous Dysplasia With External Auditory Canal Stenosis and Secondary Cholesteatoma in an Asian Population: A 11-Case Series. EAR, NOSE & THROAT JOURNAL 2020; 100:NP469-NP474. [PMID: 32438822 DOI: 10.1177/0145561320927922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE This article summarizes the experience of diagnosis and treatment of temporal bone fibrous dysplasia (FD) with external auditory canal (EAC) stenosis and secondary cholesteatoma in the Chinese population, in order to improve the quality of life of patients in the future. METHODS Eleven patients with FD of the temporal bone who underwent surgery were retrospectively reviewed. RESULTS All lesions originated from the temporal bone, and all involved of the EAC. There were 11 cases of cholesteatoma in the EAC, 4 cases of cholesteatoma in the middle ear. The most common symptoms were hearing loss (100%), tinnitus (36.4%), and otorrhea (36.4%). Two patients were severe-profound sensorineural hearing loss, and one patient was complicated with subperiosteal abscesses. All 11 patients underwent surgery. There were no perioperative complications in this series and median follow-up time was 4.2 years. CONCLUSION Temporal bone FD remains a rare diagnosis, especially in the Asian population. The lesions mainly lead to stenosis of the EAC, especially at the osteochondral junction. Cholesteatoma is the main complication of this disease, which is secondary to occlusion of the EAC with the growth of the lesion. Canaloplasty of EAC combined with wide meatoplasty can provide excellent prognosis in most cases.
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Affiliation(s)
- Kun Zhang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai, China
| | - Peng Qu
- Graduate School, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bing Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai, China
| | - Endong Zhang
- Department of Otorhinolaryngology, Affiliated WeiHai Hospital, Qingdao University, Shandong, China
| | - Bing Chen
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai, China
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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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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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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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Keller RG, Ong AA, Nguyen SA, O'Connell BP, Lambert PR. Postinflammatory medial canal fibrosis: An institutional review and meta-analysis of short- and long-term outcomes. Laryngoscope 2016; 127:488-495. [DOI: 10.1002/lary.26214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/29/2016] [Accepted: 07/06/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Robert G. Keller
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Adrian A. Ong
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Shaun A. Nguyen
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Brendan P. O'Connell
- Department of Otolaryngology-Head and Neck Surgery; Vanderbilt University Medical Center; Nashville Tennessee U.S.A
| | - Paul R. Lambert
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
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