Original contributionThe one-cut meatoplasty: novel surgical technique and outcomes☆
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.
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Financial Material & Support: No funding or other support was required for this study.