Acquired atresia of the external auditory canal and canaloplasty with Thiersch graft reconstruction: Outcomes and complications

Annalisa Pace; Valeria Rossetti; Giannicola Iannella; Irene Claudia Visconti; Alessandro Milani; Roberta Polimeni; Antonino Maniaci; Salvatore Cocuzza; Massimo Re; Giuseppe Magliulo

doi:10.17305/bjbms.2022.7676

Authors

Annalisa Pace Sense Organs Department, Sapienza University of Rome, Rome, Italy; Surgical Sciences Department, Sapienza University of Rome, Rome, Italy https://orcid.org/0000-0001-6744-5280
Valeria Rossetti Sense Organs Department, Sapienza University of Rome, Rome, Italy
Giannicola Iannella Sense Organs Department, Sapienza University of Rome, Rome, Italy
Irene Claudia Visconti Sense Organs Department, Sapienza University of Rome, Rome, Italy
Alessandro Milani Sense Organs Department, Sapienza University of Rome, Rome, Italy https://orcid.org/0000-0002-5769-7000
Roberta Polimeni Sense Organs Department, Sapienza University of Rome, Rome, Italy
Antonino Maniaci Sense Organs Department, Sapienza University of Rome, Rome, Italy https://orcid.org/0000-0002-1251-0185
Salvatore Cocuzza Otorhinolaryngology Department, University of Catania, Catania, Italy
Massimo Re Clinical Science Department, Polytechnic University of Marche, Marche, Italy
Giuseppe Magliulo Sense Organs Department, Sapienza University of Rome, Rome, Italy https://orcid.org/0000-0003-3052-1969

DOI:

https://doi.org/10.17305/bjbms.2022.7676

Keywords:

acquired atresia, external auditory canal, endoaural surgery, canaloplasty, skin graft

Abstract

Acquired atresia of the external auditory canal (EAC) is a rare disease characterized by otorrhea and progressive hearing loss. Clinically, it is differentiated into two stages: the wet stage and the dry stage. The dry stage does not respond to pharmacological treatment and has to be treated surgically. One surgical option is canaloplasty of the EAC with Thiersch graft reconstruction. This study aimed to report the follow-up outcomes (otomicroscopic signs and pure tone audiometry [PTA]) in patients with acquired atresia treated with this technique. Eighteen adult patients surgically treated for acquired atresia of the EAC between 2010 and 2020 were enrolled. All underwent canaloplasty with Thiersch graft reconstruction by one senior surgeon. Otomicroscopy and PTA results were evaluated before and after surgery. Postsurgical follow-up was performed at 1-3-6-12 months and then annually. Presurgical otomicroscopic examination revealed stenosis that occluded more than 75% of the EAC in all patients, and preoperative PTA showed conductive hearing loss in 89% of patients. However, postsurgical otomicroscopic examination showed that 94% of patients had a normal EAC diameter after one year, and only one patient had anterior blunting and recurrent atresia. In addition, postsurgical PTA evidenced a normal range in 89% of patients after one year. In conclusion, acquired atresia of the EAC is a troublesome disease usually associated with hearing loss. Therefore, treatment is chosen to resolve its symptoms. The results demonstrate evidence that canaloplasty with Thirsch graft may be a suitable surgical method considering the lower incidence of recurrence and the excellent hearing outcomes.