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Elzomor A, Firlie M, Orobello N, Murnick J, Reilly BK. Cholesteatoma: Canalplasty for External Auditory Stenosis in a Pediatric Patient. Cureus 2023; 15:e51188. [PMID: 38283428 PMCID: PMC10817763 DOI: 10.7759/cureus.51188] [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: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
External auditory canal (EAC) stenosis is the narrowing of the external auditory meatus to less than 4 mm. Severe stenosis of the EAC may inhibit the ability to conduct sound and may lead to the formation of a cholesteatoma. While most cases of EAC stenosis may be managed nonoperatively, the significant impact that the associated symptoms can have on patients may require surgical intervention. Progression of the cholesteatoma can erode the bony ossicles, may encase the facial nerve, and impact infection risk causing chronic otorrhea, and further worsening patient quality of life. We present the case of a pediatric patient who presented due to chronic left-sided hearing loss. Further examination and imaging demonstrated near-total obstruction of the left EAC secondary to a soft tissue mass and evidence of bony hypertrophy. Following a canalplasty, the patient now has returned to baseline hearing and has no associated complications. Canalplasty remains a safe, effective surgical intervention for EAC stenosis complicated by cholesteatoma.
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Affiliation(s)
- Amir Elzomor
- Division of Otolaryngology, Head and Neck Surgery, The George Washington University School of Medicine, Washington, USA
| | - Marissa Firlie
- Division of Otolaryngology, Head and Neck Surgery, The George Washington University School of Medicine, Washington, USA
| | - Nicklas Orobello
- Department of Pediatric Otolaryngology, Children's National Medical Center, Washington, USA
| | - Jonathan Murnick
- Department of Pediatric Radiology, Children's National Medical Center, Washington, USA
| | - Brian K Reilly
- Department of Pediatric Otolaryngology, Children's National Medical Center, Washington, USA
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Abstract
Congenital anomalies of the external auditory canal (EAC) are classically divided into congenital aural atresia (CAA) and congenital aural stenosis (CAS). CAA can present as an isolated anomaly, unilateral or bilateral, or in the setting of a craniofacial syndrome. Hearing testing (ABR with air and bone conduction thresholds for both ears) early in the perinatal period is important to document hearing thresholds. Hearing status thus informs parent counseling on options for hearing habilitation: Bone conducting technology is a must for children with bilateral CAA to support normal speech and language development. Bone conducting technology should be considered for children with unilateral CAA; benefits are unclear. In select candidates, atresia repair can provide improved hearing with a clean, dry, epithelialized ear canal. First branchial cleft cyst or sinus is rare; high index of suspicion is needed to diagnose along with high-resolution CT. Congenital aural stenosis (CAS) is a rare condition, and hearing testing should be similar to that in children with CAA. Early (age 4-5) CT imaging is recommended in the setting of a canal <2 mm or pinpoint canal to evaluate for trapped skin/ear canal cholesteatoma.
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Affiliation(s)
- Daniel Morrison
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia School of Medicine, University of Virginia Department of Otolaryngology, Box 800713, Charlottesville, VA, USA
| | - Bradley Kesser
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia School of Medicine, University of Virginia Department of Otolaryngology, Box 800713, Charlottesville, VA, USA.
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Shannon CM, Gutierrez JA, Nguyen SA, Meyer TA, Lambert PR. Comparison of Outcomes of Surgery Versus Implantable Device for the Treatment of Hearing Loss Associated With Congenital Aural Atresia: A Systematic Review and Meta-Analysis. Otol Neurotol 2023; 44:758-766. [PMID: 37464461 DOI: 10.1097/mao.0000000000003950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To compare audiometric outcomes, complications, and revisions required for implantable bone-conduction devices (BCDs) versus atresia surgery for the treatment of hearing loss associated with congenital aural atresia. DATABASES REVIEWED PubMed, Scopus, CINAHL. METHODS Databases were searched for English articles from inception to July 1, 2022, for studies reporting audiometric outcomes or complications for either BCDs or atresia surgery for the treatment of congenital aural atresia. Main outcome measures included pure-tone audiometry, air-bone gap, speech reception threshold, associated complications, and rates of revision for each treatment option. RESULTS We identified 973 abstracts, of which 89 were selected for data extraction and analysis. A total of 2,611 patients were included, 1,901 in the atresia surgery group and 710 in the BCDs group. A meta-analysis of single means was conducted for age and audiometric outcomes, and a meta-analysis of proportions was conducted for complications and revisions. The average short-term improvement in pure-tone audiometry for the BCDs group was 34.4 ± 1.6 dB compared with 22.4 ± 1.5 dB for the atresia surgery group, representing a significant difference (12.0 dB; 95% confidence interval, 11.9-12.2; p < 0.0001). A smaller proportion of complications were reported in the devices group (16.9%) compared with the atresia surgery group (45.7%). In addition, a smaller proportion of cases in the devices group required some degree of revision (17.8%) compared with the atresia surgery group (23.0%). CONCLUSIONS This study demonstrates that implantable BCDs have significantly better audiometric outcomes as well as a lower rate of complications and revisions required compared with atresia surgery.
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Affiliation(s)
- Christian M Shannon
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Lee CR, Yoon S, Kim JH, Choi J, Park KH, Oh DY. The cover of an ear thermometer probe as a split-thickness skin graft mold in external auditory canal reconstruction. Arch Craniofac Surg 2023; 24:198-201. [PMID: 37654242 PMCID: PMC10475699 DOI: 10.7181/acfs.2023.00157] [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: 03/31/2023] [Revised: 05/11/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023] Open
Abstract
Maintaining the patency of the external auditory canal (EAC) during reconstruction is important because of its physiological role in hearing and immunological protective functions. The curved shape of the EAC presents a challenge when performing a skin graft. One of the key points for a successful skin graft is to ensure compression on the wound bed, and many novel methods, including prefabricated ear molds, have been reported for this purpose. In this study, we present a case of a skin graft performed to reconstruct a skin defect following excision of actinic keratosis in the EAC, using the cover of an ear thermometer probe as a mold for the graft to match the curvature of the EAC. This is an economical and practical method for secure compression dressing of a skin graft in the EAC.
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Affiliation(s)
- Chae Rim Lee
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sungyeon Yoon
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hun Kim
- Department of Plastic and Reconstructive Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jangyoun Choi
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung Ho Park
- Department of Otolaryngology-Head & Neck Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Deuk Young Oh
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Matin-Mann F, Gao Z, Schwieger J, Ulbricht M, Domsta V, Senekowitsch S, Weitschies W, Seidlitz A, Doll K, Stiesch M, Lenarz T, Scheper V. Individualized, Additively Manufactured Drug-Releasing External Ear Canal Implant for Prevention of Postoperative Restenosis: Development, In Vitro Testing, and Proof of Concept in an Individual Curative Trial. Pharmaceutics 2022; 14:pharmaceutics14061242. [PMID: 35745813 PMCID: PMC9228097 DOI: 10.3390/pharmaceutics14061242] [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: 05/13/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022] Open
Abstract
Postoperative restenosis in patients with external ear canal (EEC) atresia or stenosis is a common complication following canaloplasty. Our aim in this study was to explore the feasibility of using a three dimensionally (3D)-printed, patient-individualized, drug ((dexamethasone (DEX)), and ciprofloxacin (cipro))-releasing external ear canal implant (EECI) as a postoperative stent after canaloplasty. We designed and pre-clinically tested this novel implant for drug release (by high-performance liquid chromatography), biocompatibility (by the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay), bio-efficacy (by the TNF-α (tumor necrosis factor-alpha)-reduction test (DEX) and inhibition zone test (for cipro)), and microbial contamination (formation of turbidity or sediments in culture medium). The EECI was implanted for the first time to one patient with a history of congenital EEC atresia and state after three canaloplasties due to EEC restenosis. The preclinical tests revealed no cytotoxic effect of the used materials; an antibacterial effect was verified against the bacteria Staphylococcus aureus and Pseudomonas aeruginosa, and the tested UV-irradiated EECI showed no microbiological contamination. Based on the test results, the combination of silicone with 1% DEX and 0.3% cipro was chosen to treat the patient. The EECI was implantable into the EEC; the postoperative follow-up visits revealed no otogenic symptoms or infections and the EECI was explanted three months postoperatively. Even at 12 months postoperatively, the EEC showed good epithelialization and patency. Here, we report the first ever clinical application of an individualized, drug-releasing, mechanically flexible implant and suggest that our novel EECI represents a safe and effective method for postoperatively stenting the reconstructed EEC.
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Affiliation(s)
- Farnaz Matin-Mann
- Department of Otorhinolaryngology, Head and Neck Surgery, Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany; (Z.G.); (J.S.); (T.L.); (V.S.)
- Correspondence: ; Tel.: +49-511-532-6565; Fax: +49-511-532-8001
| | - Ziwen Gao
- Department of Otorhinolaryngology, Head and Neck Surgery, Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany; (Z.G.); (J.S.); (T.L.); (V.S.)
- Cluster of Excellence”Hearing4all” EXC 1077/1, 30625 Hannover, Germany
| | - Jana Schwieger
- Department of Otorhinolaryngology, Head and Neck Surgery, Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany; (Z.G.); (J.S.); (T.L.); (V.S.)
- Cluster of Excellence”Hearing4all” EXC 1077/1, 30625 Hannover, Germany
| | - Martin Ulbricht
- Center of Drug Absorption and Transport, Department of Biopharmacy and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, 17489 Greifswald, Germany; (M.U.); (V.D.); (S.S.); (W.W.); (A.S.)
| | - Vanessa Domsta
- Center of Drug Absorption and Transport, Department of Biopharmacy and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, 17489 Greifswald, Germany; (M.U.); (V.D.); (S.S.); (W.W.); (A.S.)
| | - Stefan Senekowitsch
- Center of Drug Absorption and Transport, Department of Biopharmacy and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, 17489 Greifswald, Germany; (M.U.); (V.D.); (S.S.); (W.W.); (A.S.)
| | - Werner Weitschies
- Center of Drug Absorption and Transport, Department of Biopharmacy and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, 17489 Greifswald, Germany; (M.U.); (V.D.); (S.S.); (W.W.); (A.S.)
| | - Anne Seidlitz
- Center of Drug Absorption and Transport, Department of Biopharmacy and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, 17489 Greifswald, Germany; (M.U.); (V.D.); (S.S.); (W.W.); (A.S.)
- Institute of Pharmaceutics and Biopharmaceutics, University of Duesseldorf, 40225 Dusseldorf, Germany
| | - Katharina Doll
- Clinic for Dental Prosthetics and Biomedical Materials Science, Hanover Medical School, 30625 Hannover, Germany; (K.D.); (M.S.)
| | - Meike Stiesch
- Clinic for Dental Prosthetics and Biomedical Materials Science, Hanover Medical School, 30625 Hannover, Germany; (K.D.); (M.S.)
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Head and Neck Surgery, Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany; (Z.G.); (J.S.); (T.L.); (V.S.)
- Cluster of Excellence”Hearing4all” EXC 1077/1, 30625 Hannover, Germany
| | - Verena Scheper
- Department of Otorhinolaryngology, Head and Neck Surgery, Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany; (Z.G.); (J.S.); (T.L.); (V.S.)
- Cluster of Excellence”Hearing4all” EXC 1077/1, 30625 Hannover, Germany
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Hempel JM, Epp A, Volgger V. [Hearing rehabilitation with the Vibrant Soundbridge in patients with congenital middle ear malformation]. HNO 2021:10.1007/s00106-021-01004-5. [PMID: 33599810 DOI: 10.1007/s00106-021-01004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Congenital aural atresia, which is usually unilateral, causes hearing loss and aesthetic impairment. Besides tympanoplasty with/without canalplasty and bone conduction devices, active middle ear implants are also available for functional rehabilitation. OBJECTIVE This article aims to present a contemporary review on the treatment possibilities for middle ear malformations, with a focus on audiological rehabilitation with the Vibrant Soundbridge. MATERIALS AND METHODS A selective literature search for treatment possibilities was performed in PubMed up to October 2020, and personal clinical experiences are reported. RESULTS The Vibrant Soundbridge, which is approved for children ≥ 5 years, is suitable for treatment of middle ear malformations with a Jahrsdoerfer score ≥ 5. Although implantation of a Vibrant Soundbridge is surgically more demanding than implantation of a bone conduction device, the method is safe, delivers good auditory results (superior to bone conduction devices in terms of speech understanding and spatial hearing), does not involve intensive postsurgical care, and rarely requires revision surgery. The Vibrant Soundbridge can be coupled to (remnants of) the ossicular chain or the round window. CONCLUSION The Vibrant Soundbridge is an appropriate treatment method in patients with middle ear malformations who have suitable anatomical preconditions.
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Affiliation(s)
- J M Hempel
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, LMU Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
| | - A Epp
- Kinderklinik, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - V Volgger
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, LMU Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland
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Mozaffari M, Nash R, Tucker AS. Anatomy and Development of the Mammalian External Auditory Canal: Implications for Understanding Canal Disease and Deformity. Front Cell Dev Biol 2021; 8:617354. [PMID: 33553153 PMCID: PMC7857502 DOI: 10.3389/fcell.2020.617354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/11/2020] [Indexed: 12/15/2022] Open
Abstract
The mammalian ear is made up of three parts (the outer, middle, and inner ear), which work together to transmit sound waves into neuronal signals perceived by our auditory cortex as sound. This review focuses on the often-neglected outer ear, specifically the external auditory meatus (EAM), or ear canal. Within our complex hearing pathway, the ear canal is responsible for funneling sound waves toward the tympanic membrane (ear drum) and into the middle ear, and as such is a physical link between the tympanic membrane and the outside world. Unique anatomical adaptations, such as its migrating epithelium and cerumen glands, equip the ear canal for its function as both a conduit and a cul-de-sac. Defects in development, or later blockages in the canal, lead to congenital or acquired conductive hearing loss. Recent studies have built on decades-old knowledge of ear canal development and suggest a novel multi-stage, complex and integrated system of development, helping to explain the mechanisms underlying congenital canal atresia and stenosis. Here we review our current understanding of ear canal development; how this biological lumen is made; what determines its location; and how its structure is maintained throughout life. Together this knowledge allows clinical questions to be approached from a developmental biology perspective.
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Affiliation(s)
- Mona Mozaffari
- Centre for Craniofacial and Regenerative Biology, King's College London, Guy's Hospital, London, United Kingdom
| | - Robert Nash
- Department of Paediatric Otolaryngology, Cochlear Implants, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Abigail S Tucker
- Centre for Craniofacial and Regenerative Biology, King's College London, Guy's Hospital, London, United Kingdom
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Lee MY, Cho YS, Han GC, Oh JH. Current Treatments for Congenital Aural Atresia. J Audiol Otol 2020; 24:161-166. [PMID: 33070563 PMCID: PMC7575916 DOI: 10.7874/jao.2020.00325] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/15/2020] [Indexed: 11/22/2022] Open
Abstract
Congenital aural atresia is an ear malformation evident at birth, involving various degrees of failed external ear canal development. A true external ear canal is desirable, as devices that replace the canal are inconvenient and expensive. Therefore, an optimal surgical technique is required. Here, we review useful preoperative and operative techniques. Surgical correction is often not the preferred treatment; the hearing outcome is no better than the outcomes afforded by bone-conduction devices, and surgery may be associated with recurrence or complications such as meatal stenosis. Preoperative evaluation and appropriate management are important. Several means of preventing meatal stenosis are discussed in this review.
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Affiliation(s)
- Min Young Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University Hospital, Cheonan, Korea
| | - Yang-Sun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Gyu Cheol Han
- Department of Otolaryngology-Head and Neck Surgery, Gachon University of Medicine and Science, Graduate School of Medicine, Incheon, Korea
| | - Jeong-Hoon Oh
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
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Congenital soft tissue stenosis of the external auditory canal with canal cholesteatoma: Case report and literature review. Int J Pediatr Otorhinolaryngol 2020; 134:110053. [PMID: 32344234 DOI: 10.1016/j.ijporl.2020.110053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 11/22/2022]
Abstract
Congenital external auditory canal stenosis (EACS) is a spectrum of abnormalities affecting the external and middle ear. We report a 6 year-old patient with EACS affecting the lateral fibrocartilaginous canal that was successfully repaired. This patient highlights a variant of EACS characterized by lateral soft tissue narrowing with normal osseous development. Most previous studies of CAA have described severe forms associated with complete atresia, bony stenosis, and middle ear malformations. Stenosis affecting only the fibrocartilaginous canal is a milder form resulting from premature arrest of the canalization process during embryologic development, and may predispose to cholesteatoma formation.
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Firouzbakht PK, Saa L, Varman RM, Nguyen TQ. Spinning FlexHD canaloplasty following parotidectomy: A case report. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2019.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
OBJECTIVE Describe long-term trends and stability of hearing outcomes for patients undergoing primary congenital aural atresia (CAA) repair. STUDY DESIGN Retrospective chart review. SETTING Single academic, tertiary referral center. PATIENTS Children and adults who underwent primary CAA repair between 1980 and 2017. INTERVENTION CAA repair. MAIN OUTCOME MEASURES Long-term (> 1 yr) postoperative three-tone (500, 1000, 2000 Hz) air conduction pure-tone average (AC PTA) compared with the immediate (within 90 d of surgery) postoperative audiogram. RESULTS The mean preoperative AC PTA was 59.6 dB HL. CAA repair improved hearing an average of 30.5 dB, but hearing declined by 8.2 dB over the long-term follow-up period (mean 4.4 yr; range 1-15.7 yr), leaving a final mean improvement of 22.2 dB (final mean AC PTA 37.3 dB HL). Two-thirds (92 of 138 ears) had an AC PTA ≤ 30 dB HL recorded in the first year after surgery. At the last follow-up test, 64% had "stable" hearing defined as no more than a 10 dB decline in AC PTA compared with the immediate postoperative audiogram; 21% had a 10 to 20 dB decline, 8% a 20 to 30 dB decline, and 7% declined > 30 dB. CONCLUSIONS All patients enjoyed improvement in AC PTA after surgery (preoperative minus the best postoperative PTA, mean = 34 dB, range = 3.3-52 dB). Hearing declined by an average 8.2 dB over the long-term leaving a final average AC PTA of 37.4 dB HL. Sixty-four percent of patients exhibited stable (< 10 dB loss) hearing over time; 36% lost 10 dB or more over the long-term follow-up period. Hearing results typically stabilize over time with most of the change occurring in the first 3 years after CAA repair. Bone conduction thresholds remained stable over the study period.
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Long-term Hearing Outcome of Canaloplasty With Partial Ossicular Replacement in Congenital Aural Atresia. Otol Neurotol 2019; 39:602-608. [PMID: 29664866 DOI: 10.1097/mao.0000000000001785] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to correlate the postoperative hearing outcomes with regard to the length of prosthesis of the partial ossicular replacement prosthesis (PORP) in patients with congenital aural atresia. STUDY DESIGN Retrospective review of medical records. SETTING, PATIENTS, INTERVENTION, MAIN OUTCOME MEASURE The medical records of 131 patients (132 ears) who underwent canaloplasty with PORP by a single surgeon from 2011 to 2016 were reviewed for demographic data, Jahrsdoerfer score, grade of microtia, length of prosthesis, and audiometric outcomes. Air conduction, bone conduction threshold, and air-bone gap were measured preoperatively and at 3-, 6-, 12-, and 24-months of follow-up. Patients were divided into two groups according to the postoperative hearing outcomes, and the length of PORP was compared between the two groups. Univariable and multivariable generalized estimating equations were used to investigate other favorable prognostic factors for long-term postoperative hearing results. RESULTS When the improvement of the air-bone gap within 30 dB was defined as successful hearing outcome, no significant differences were observed for prosthesis length between two groups at 3, 6, and 12 months postoperatively. However, at 2-year follow-up, mean length of prosthesis was significantly shorter (p = 0.006) for the success group (2.30 ± 0.53 mm) than for the nonsuccess group (2.77 ± 0.73 mm). Generalized estimating equations revealed PORP length as the only factor significantly associated with favorable long-term hearing results. CONCLUSION Long-term hearing outcome of canaloplasty with PORP is likely to be affected by prosthesis length. For that reason, making the neo-annulus as medial as possible to shorten the length of the appropriate prosthesis is important for successful long-term hearing outcomes.
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Predictive Factors for Hearing Outcomes After Canaloplasty in Patients With Congenital Aural Atresia. Otol Neurotol 2017; 38:1140-1144. [DOI: 10.1097/mao.0000000000001504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pan JC, Harris TM. External auditory canal stenting with nonlatex glove and Gelfoam. EAR, NOSE & THROAT JOURNAL 2017; 95:E25-6. [PMID: 26930340 DOI: 10.1177/014556131609500208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
External auditory canal stenosis, although uncommon, is a condition that is sometimes encountered by otolaryngologists. This condition has been shown to result from inflammatory changes that may be incited by many different causes. Various methods of stenting the canal open postoperatively have been described. We describe a readily accessible and inexpensive method of stenting the canal open postoperatively. The technique presented has been used effectively in all age groups at our institution, in cases ranging from trauma to postmastoidectomy procedures.
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Affiliation(s)
- Judy C Pan
- Corresponding author: Judy Pan, MD, Department of Otolaryngology and Communication Sciences, College of Medicine, SUNY Upstate Medical University, 241 Campus West, 750 East Adams St., Syracuse, NY 13210. From the Department of Otolaryngology and Communication Sciences, College of Medicine, Upstate Medical University, State University of New York, Syracuse
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15
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Long-term result of meatoplasty using inferiorly based retroauricular island pedicle flap for external auditory canal stenosis. Auris Nasus Larynx 2016; 43:382-6. [DOI: 10.1016/j.anl.2015.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/29/2015] [Accepted: 09/08/2015] [Indexed: 11/21/2022]
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16
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Li CL, Dai PD, Yang L, Zhang TY. A meta-analysis of the long-term hearing outcomes and complications associated with atresiaplasty. Int J Pediatr Otorhinolaryngol 2015; 79:793-797. [PMID: 25912684 DOI: 10.1016/j.ijporl.2015.03.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To summarize peer-reviewed literature to evaluate the stability of long-term hearing outcomes with prolonged follow-up, and describe the incidence of complications related to atresiaplasty. DESIGN A literature search of EMBASE, MEDLINE, PubMed, Google Scholar, and Web of Science was performed to identify studies of congenital aural atresia (CAA). STUDY SAMPLE Selected studies were published between 1997 and 2014. The 19 studies covered 964 CAA ears. RESULTS Stenosis and bony regrowth occurred in 14.2% (range from 0% to 30.3%). Lateralization of tympanic membrane (TM) occurred in 7.5% (range from 0% to 18.2%). Facial nerve palsy occurred in 0.5% (range from 0% to 5.0%). Six studies used Air-bone Gap (ABG) to evaluate the short-term and long-term hearing outcomes. The hearing outcomes were performed using meta-analysis, there was no significantly heterogeneity (I(2) = 0%, p = 0.997), and there was a degradation of hearing outcomes with prolonged follow-up (RR = 1.13, 95%CI: 0.98-1.30). CONCLUSION Nearly all studies focus on postoperative stenosis and bony regrowth, but some studies neglect lateralization of TM. Based on available data, which shows a lack of major complications, such as facial nerve palsy, atresiaplasty is a safe procedure. Our meta-analysis indicated that there was a degradation of hearing outcomes with prolonged follow-up.
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Affiliation(s)
- Chen-Long Li
- Department of Otolaryngology - Head and Neck Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Pei-Dong Dai
- Research Center, Eye & ENT Hospital, Fudan University, Shanghai, China; Hearing Medicine Key Laboratory, National Ministry of Public Health, Shanghai, China
| | - Lin Yang
- Research Center, Eye & ENT Hospital, Fudan University, Shanghai, China; Hearing Medicine Key Laboratory, National Ministry of Public Health, Shanghai, China
| | - Tian-Yu Zhang
- Department of Otolaryngology - Head and Neck Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China; Hearing Medicine Key Laboratory, National Ministry of Public Health, Shanghai, China.
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Abstract
CONCLUSION Surgery candidacy based on the surgical accessibility of the middle ear seems more valuable than the use of a preoperative grading system. Also patients with severe malformations can benefit from surgical reconstruction. OBJECTIVE To evaluate the long-term results of the primary surgical treatment of patients with congenital auricular atresia (CAA). METHODS One hundred patients with CAA underwent surgical reconstruction between 1985 and 2010. The mean follow-up time was 40 months. All patients were retrospectively scored using the Jahrsdoerfer grading scale and divided into two groups according to the grade of their malformation. Group 1 included 20 patients with scores of 4-6 and group 2 included 80 patients with scores of 7-10. Pre- and postoperative air conduction (AC), bone conduction (BC), pure-tone average 'air-bone gap' (PTA₄-ABG), surgical findings, postoperative complications, and revision surgeries performed were determined and compared between the two groups. RESULTS For 90% of the patients in group 1 and 79% of the patients in group 2, the postoperative ABG was within 0 and 30 dB. The most common complications were recurrent infection, lateralization of the tympanic membrane, and restenosis of the ear canal.
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Affiliation(s)
- Lennart Edfeldt
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head and Neck Surgery, Uppsala University , Uppsala , Sweden
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Abstract
Congenital aural atresia is a spectrum of ear deformities present at birth that involves some degree of failure of the development of the external auditory canal. This malformation may be associated with other congenital anomalies; it occurs as a result of abnormal development of the first and second branchial arches and the first branchial cleft and most often occurs sporadically, although the disease may be manifested in different syndromes. Congenital aural atresia is considered one of the most difficult and challenging surgeries for the otologic surgeon. The goals of atresia surgery are to restore functional hearing, preferably without the requirement of a hearing aid, and to reconstruct a patent, infection-free external auditory canal. The repair is usually done at the age of 6 years, so children with bilateral atresia may need hearing amplification in the first few weeks of life until the age at surgery. To optimize the surgical outcome, careful audiological and radiological evaluation of the patient should be performed preoperatively. Also, postoperative frequent packing and regular follow-up are mandatory to avoid restenosis and infection of the newly created canal. With careful intraoperative dissection and regular follow-up, complications of surgery can be avoided.
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Li C, Zhang T, Fu Y, Qing F, Chi F. Congenital aural atresia and stenosis: Surgery strategies and long-term results. Int J Audiol 2014; 53:476-81. [DOI: 10.3109/14992027.2014.890295] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sound Localization Performance Improves After Canaloplasty in Unilateral Congenital Aural Atresia Patients. Otol Neurotol 2014; 35:639-44. [DOI: 10.1097/mao.0000000000000271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Han H, Wang H, Zhou L, Li B, Wang G, Wang P, Ding R, Wu W. One-stage reconstruction of two atypical small concha-type microtic ears. Int J Pediatr Otorhinolaryngol 2014; 78:693-6. [PMID: 24512785 DOI: 10.1016/j.ijporl.2014.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/13/2014] [Accepted: 01/14/2014] [Indexed: 11/26/2022]
Abstract
This report presents 2 cases of atypical small concha-type microtia, which were reconstructed with full utilization of the remnant cartilage. To repair the deformity, we harvested the 8th and 9th costal cartilage to form the helix and anthelix structure. The remnant auricular cartilage mass was retained and utilized as the base block of the framework, onto which sculptured helical rim and anthelix were added. Thus an ear of symmetrical shape, projection and visible convolutions was reconstructed. We suggest making use of the remnant cartilage to minimize the donor site morbidity, especially for mild to moderate microtia reconstruction.
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Affiliation(s)
- Haolun Han
- Department of Otolaryngology-Head and Neck Surgery, The 306th Hospital of PLA, Beijing 100101, PR China
| | - Hongnan Wang
- Department of Otolaryngology-Head and Neck Surgery, The 306th Hospital of PLA, Beijing 100101, PR China
| | - Libin Zhou
- Department of Otolaryngology-Head and Neck Surgery, The 306th Hospital of PLA, Beijing 100101, PR China
| | - Baowei Li
- Department of Otolaryngology-Head and Neck Surgery, The 306th Hospital of PLA, Beijing 100101, PR China
| | - Gang Wang
- Department of Otolaryngology-Head and Neck Surgery, The 306th Hospital of PLA, Beijing 100101, PR China
| | - Peilin Wang
- Department of Otolaryngology-Head and Neck Surgery, The 306th Hospital of PLA, Beijing 100101, PR China
| | - Ruiying Ding
- Department of Otolaryngology-Head and Neck Surgery, The 306th Hospital of PLA, Beijing 100101, PR China
| | - Wei Wu
- Department of Otolaryngology-Head and Neck Surgery, The 306th Hospital of PLA, Beijing 100101, PR China.
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Using nasopharyngeal tube to stent external auditory canal in atresia repair. J Plast Reconstr Aesthet Surg 2014; 67:e144-5. [PMID: 24444797 DOI: 10.1016/j.bjps.2014.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 01/03/2014] [Indexed: 11/22/2022]
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Chen J, Liang H, Wang Y, Yu Y. Applications of titanium mesh tubing in external ear canal reconstruction in congenital aural atresia. Eur Arch Otorhinolaryngol 2014; 272:835-838. [PMID: 24442665 DOI: 10.1007/s00405-014-2888-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/09/2014] [Indexed: 10/25/2022]
Abstract
The aim of this study was to observe the effect of a titanium tube on external auditory canal reconstruction in congenital aural atresia and to assess the tube's effectiveness in preventing external canal stenosis or atresia after reconstruction. Reconstruction of the external ear canal with a titanium mesh tube was performed in 16 patients (16 ears) with congenital aural atresia at the First People's Hospital of Foshan. The titanium mesh tube was removed 1 year after surgery. The patients were followed up for 2 years (2 ± 0.3 years), and all of the patients had formed a new external ear canal. There was no local infection, granulation tissue, re-stenosis, or atresia in any of the patients after surgery. All of the patients were content with their newly formed external ear canal. Titanium mesh tubing is safe and effective for reconstruction of the external ear canal during surgery for congenital aural atresia.
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Affiliation(s)
- Junming Chen
- Department of Otolaryngology, The First People's Hospital of Foshan, 5280002, Foshan, People's Republic of China
| | - Hairong Liang
- Department of Otolaryngology, The First People's Hospital of Foshan, 5280002, Foshan, People's Republic of China
| | - Yuejian Wang
- Department of Otolaryngology, The First People's Hospital of Foshan, 5280002, Foshan, People's Republic of China.
| | - Youjun Yu
- Department of Otolaryngology, The First People's Hospital of Foshan, 5280002, Foshan, People's Republic of China
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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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25
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Benefit of a new hearing device utilizing cartilage conduction. Auris Nasus Larynx 2013; 40:440-6. [DOI: 10.1016/j.anl.2012.12.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 12/06/2012] [Accepted: 01/11/2013] [Indexed: 11/15/2022]
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Hearing Outcomes of Atresia Surgery Versus Osseointegrated Bone Conduction Device in Patients With Congenital Aural Atresia. Otol Neurotol 2013; 34:1394-9. [DOI: 10.1097/mao.0b013e3182a36065] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nicholas BD, Kesser BW. Unilateral Aural Atresia: Current Management Issues and Results. CURRENT OTORHINOLARYNGOLOGY REPORTS 2013. [DOI: 10.1007/s40136-013-0014-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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