Elsevier

Auris Nasus Larynx

Volume 43, Issue 4, August 2016, Pages 382-386
Auris Nasus Larynx

Long-term result of meatoplasty using inferiorly based retroauricular island pedicle flap for external auditory canal stenosis

https://doi.org/10.1016/j.anl.2015.09.002Get rights and content

Abstract

Objective

To characterize the long-term outcomes of meatoplasty using our new technique, inferiorly based retroauricular island pedicle flap for external auditory canal (EAC) stenosis.

Methods

A long-term clinical analysis of meatoplasty for nine patients (mean age, 33 years; age range, 8–64 years) with stenotic EAC was performed. The follow-up period after meatoplasty ranged from 5 years to 14 years, with a mean duration of 8.4 years. We compared preoperative and postoperative otoscopic findings, high-resolution computed tomographic (CT) images of the EAC, and hearing levels.

Results

Otoscopic examinations demonstrated widened EAC in eight of the nine patients. There was a significant increase in the size of the EAC on postoperative CT examinations when compared with the preoperative state. The hearing outcome in all patients was variable. The postoperative air–bone gap (ABG) was closed to 10 dB or less in two cases, while the other seven cases showed ABG ranging from 15.0 dB to 57.5 dB.

Conclusions

We performed meatoplasty using inferiorly based retroauricular island pedicle flap for nine patients with EAC stenosis and eight of the nine patients demonstrated satisfactory patent EAC during a mean follow-up of 8.4 years.

Introduction

EAC stenosis is a challenging problem. Stenotic EAC hampers the self-cleaning function of the EAC skin, leading to accumulation of debris, which causes hearing loss and chronic infection. The surgical procedures for patients with stenotic EAC have been skin grafting and/or stent placement [1], [2], [3]. However, revision surgery is often required to address complications associated with the initial procedure, which include restenosis and chronic recurrent otorrhea. In order to solve such problems, a vasculized pedicled skin flap technique has been proposed by several groups of investigators [4], [5], [6], [7], [8]. Our technique is a modification of a technique described by Chole, who utilized postauricular skin used as an island pedicle graft to epithelize the posterior and inferior ear canal as well as the newly constructed tympanic membrane [4]. Stucker and Shaw described a similar method in 1991 [5]. The goal of the present study was to characterize the long-term result of our new technique, inferiorly based retroauricular island pedicle flap for EAC stenosis.

Section snippets

Subjects

The enrolled subjects were comprised of nine patients with EAC stenosis who underwent surgeries at Tokyo Medical and Dental University Hospital from August 2002 to July 2009. This study was a retrospective chart review and all procedures followed were in accordance with the World Medical Association and the Declaration of Helsinki in 2008. All the subjects gave their written informed consent to receive the surgery.

The patient age at the time of initial surgery ranged from 8 to 64 years, with an

Results

Nine patients underwent meatoplasty, as described above. Demographics and the size of the flap are shown in Table 1. Otoscopic results revealed “improvement” in eight patients and “no change” in one patient (Table 2). There was no disagreement in evaluation between investigators. No patient experienced flap failure.

The preoperative diameter of the EAC ranged from 0.1 to 5.7 mm with an average of 3.1 mm. The postoperative diameter of the EAC ranged from 3.3 to 6.7 mm with an average of 4.9 mm. All

Discussion

The EAC stenosis is either caused by congenital malformation or acquired insult, secondary to persistent otitis externa, trauma, surgery, and irradiation. The EAC stenosis restricts otoscopic examination and toilet. It also affects epithelial migration of the EAC skin, leading to chronic aural disease. Cases of narrow fibrocartilaginous canal can be associated with EAC cholesteatoma [1]. The cholesteatoma occurred in 91% of patients with the age of 12 years and older and the EAC size of 2 mm or

Conclusion

We performed meatoplasty using an inferiorly based retroauricular island pedicle flap for nine patients with EAC stenosis. Eight patients demonstrated satisfactory patent EACs during a mean follow-up of 8.4 years.

Conflict of interest

The authors declare no conflicts of interest in association with this study.

Acknowledgments

This study was supported by Grants-in-Aid for Scientific Research (Nos. 21390459 and 22659305) from the Ministry of Education, Culture, Sports, Science and Technology, Japan and by a grant-in-aid for scientific research from the Ministry of Health, Labor and Welfare of Japan (H23-kankaku-005).

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