Elsevier

American Journal of Otolaryngology

Volume 36, Issue 2, March–April 2015, Pages 130-135
American Journal of Otolaryngology

Original contribution
The one-cut meatoplasty: novel surgical technique and outcomes

https://doi.org/10.1016/j.amjoto.2014.10.002Get rights and content

Abstract

Purpose

To present the surgical technique and clinical outcomes of a novel modification to conventional meatoplasty.

Materials and methods

All consecutive patients undergoing canal wall down tympanomastoidectomy incorporating the one-cut meatoplasty technique between January 2009 and February 2013 were evaluated. Primary outcome measures included meatal stenosis requiring revision surgery, frequency of drainage beyond 2 months postoperatively and results of a composite patient questionnaire incorporating the Chronic Ear Survey.

Results

Twenty-eight of 36 (78%) eligible patients completed a questionnaire and were included. All ears underwent canal wall down tympanomastoidectomy utilizing the one-cut meatoplasty technique. At a mean follow-up of 38.0 months, the average Chronic Ear Survey score was 78.6 ± 2.6 points. There was only one case of postoperative meatal stenosis. Intermittent otorrhea developed in 14.3% of cases but was remedied by conservative measures including in-office cleaning, ototopical therapy and water precautions. Eighty-nine percent of patients denied any self-consciousness about the aesthetic appearance of the ear.

Conclusions

The one-cut meatoplasty is an effective alternative to traditional techniques that is simple to perform. The results of the Chronic Ear Survey indicate that the one-cut meatoplasty supports a stable and healthy, open cavity with functional results that compare favorably to other series evaluating canal wall down tympanomastoidectomy with traditional meatoplasty. Additionally, patients report high satisfaction with the appearance of their ear, and all hearing aid users could continue to utilize a hearing aid without feedback, pain, or other difficulties related to poor fitting.

Introduction

The primary objective in the surgical management of chronic otitis media is to create a dry and safe ear. Tympanomastoidectomy techniques in this setting can be distinguished by their treatment of the external auditory canal. The canal wall down (CWD) tympanomastoidectomy involves removal of the posterior bony canal in order to improve surgical exposure and to exteriorize refractory disease, leading to a lower rate of recidivism compared to intact canal wall (ICW) techniques [1], [2], [3], [4], [5], [6]. Conventional indications for CWD tympanomastoidectomy include recurrent or residual cholesteatoma after a prior ICW procedure, extensive erosion of the bony external ear canal, and unresectable cholesteatoma involving the facial nerve, sinus tympani, petrous carotid, Eustachian tube or labyrinth.

Meatoplasty is a crucial but often overlooked component of the CWD operation. In order to promote a dry, self-cleaning ear and to allow for in-office surveillance, the external auditory meatus must be widened. Traditionally, a large meatoplasty has been advocated to support adequate ventilation and reduce conditions favorable for microbial growth, debris accumulation and recurrent disease [1], [3], [5], [7], [8].

However, caloric disturbances, poor hearing aid fitting, and suboptimal cosmesis have all been associated with a wide meatoplasty [8], [9]. Thus, an ideal technique that affords adequate ventilation while minimizing the negative effects of exposure remains elusive. We present the surgical technique and outcomes of a simple novel method of meatoplasty that helps mitigate many drawbacks of conventional meatoplasty without sacrificing outcome.

Section snippets

Materials & methods

Following institutional review board approval (131658), a retrospective chart review was conducted, and all consecutive patients who underwent CWD tympanomastoidectomy by the senior author between January 2009 and February 2013 were identified. Primary outcome measures included: 1) postoperative meatal stenosis, 2) frequency of otorrhea, and 3) patient-reported questionnaire results. The following data were collected: basic patient demographics; number of surgeries performed prior to CWD

Results

Thirty-six patients underwent first-time CWD tympanomastoidectomy by the senior surgeon (DSH) between January 2009 and February 2013. Of these, 28 patients (15 women; median age 39.5 years, range 6–82 years) completed a questionnaire and were analyzed. The mean duration of follow-up was 38.0 months (range 14.1–61.6 months). Of the 8 patients that were excluded, 7 were lost to follow-up, and one declined participation.

Indications for surgery included both chronic otitis media with (24; 86%) and

Discussion

Our results challenge the idea that a large meatoplasty is necessary for a dry safe ear following CWD tympanomastoidectomy [1], [3], [5], [7]. The mean total CES score for the 28 patients in the current series was 78.6, which compares favorably to other studies evaluating CWD outcomes using a traditional large meatoplasty [11], [12]. The one-cut meatoplasty maintains the functionality of a large meatoplasty, while minimizing the negative effects of mastoid bowl exposure and affording a

Conclusions

The one-cut meatoplasty is a simple and effective alternative to the traditional large meatoplasty. Comparable CES scores can be achieved with the added benefits of a smaller and more natural post-operative appearance of the meatus, enhanced shielding of caloric disturbances, and a high potential for successful hearing aid fitting. We believe the one-cut meatoplasty promotes patient satisfaction without compromising disease control following CWD tympanomastoidectomy.

Acknowledgments

We would like to acknowledge Jennifer Best, MD for her contribution to medical illustrations.

References (17)

  • J.B. Nadol

    Revision mastoidectomy

    Otolaryngol Clin North Am

    (2006)
  • D.S. Haynes et al.

    Surgical management of chronic otitis media: beyond tympanotomy tubes

    Otolaryngol Clin North Am

    (2002)
  • C.G. Jackson et al.

    Open mastoid procedures: contemporary indications and surgical technique

    Laryngoscope

    (1985)
  • E. Vartiainen

    Factors associated with recurrence of cholesteatoma

    J Laryngol Otol

    (1995)
  • M.J. Syms et al.

    Management of cholesteatoma: status of the canal wall

    Laryngoscope

    (2003)
  • J.L. Sheehy

    Cholesteatoma surgery: canal wall down procedures

    Ann Otol Rhinol Laryngol

    (1988)
  • H.C. Pillsbury et al.

    Revision mastoidectomy

    Arch Otolaryngol

    (1990)
  • J.E. Osborne et al.

    Large meatoplasty technique for mastoid cavities

    Clin Otolaryngol

    (1985)
There are more references available in the full text version of this article.

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Financial Material & Support: No funding or other support was required for this study.

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