Surgical treatment of acquired atresia of external auditory canal

Background. Treatment of patients with post-inflammatory atresia of the external auditory canal (EAC) presumes significant difficulties associated with a high risk of restenosis in the late postoperative period. The recurrence rate of atresia relapse or clinically significant stenosis varies between 28–100%.

Objective: to improve the efficacy of acquired EAC atresia surgical treatment. Forty six patients with acquired atresia (31 patients with acquired post-inflammatory atresia — group I, 11 patients with postoperative atresia — group IIa, and 5 patients with post-traumatic atresia — group IIb) underwent surgical treatment. Patients in groups I and IIa had canaloplasty until the tympanic membrane was fully visualized, atretic fibrous tissue removed and tympanic volume increased. We used an electro-magnetic navigation system to avoid traumatization of the temporomandibular joint, the internal carotid artery and the bulbs of the internal jugular vein. Ossiculoplasty and myringoplasty with the use of auto-fascial transplant were performed if defects in the sound-conducting system of the middle ear were found. It was possible to form a flap from preserved EAC skin completely covering the anterior meato-tympanic angle up to the fibrous ring in 32 cases. Skin grafts from the auricular region were used in 10 cases. The dissection of cicatricial atresia with circular excision of cartilage in the membranous EAC cartilage was performed in patients from group IIb.

Results. Anatomical and functional results were evaluated in the nearest (before discharge from the hospital) and long-term (from 12 to 30 months) postoperative period. In one patient, the thresholds of air conduction approached the pre-operative level in the late postoperative period. The revision surgery revealed the cicatricial process in the tympanic cavity and the fusion of the hammer bone manubrium with the cape. In 5 patients with concomitant dermatological pathology, atresia recurred in 2 cases and persistent EAC skin inflammation and the neotympanic membrane without impairment of hearing were detected in 3 cases. In the remaining patients, the anatomical results were assessed as satisfactory; no re-stenosis or atresia of EAC was recorded in the postoperative period. At 1 month, the bone-air interval decreased by 18.1 dB in patients of group 1, by 20.4 dB – 2a groups and by 17 dB – 2b groups, in average, and remained stable after 1 year in patients with satisfactory anatomical results.

Conclusion. The described surgical methods, together with long and careful postoperative observation, allowed achieving good anatomical results (in 87% of cases) and a persistent improvement in hearing. The proposed surgical tactics may reduce the risk of developing postoperative atresia.

Key words: acquired atresia, external auditory canal, otosurgery, tympanoplasty

The authors declare no conflict of interest. Source of financing: not specified.

For citation: Diab H.M., Kondratchikov D.S., Korvyakov V.S., Rakhmatullaev M.Sh. Surgical treatment of acquired atresia of external auditory canal. Head and neck Russian Journal. 2019;7(1):19–23 (in Russian).

The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, figures, photographs of patients.