Outcomes of Drill Canalplasty in Exostoses and Osteoma: Analysis of 256 Cases and Literature Review.

OBJECTIVE

1) To describe the surgical technique of drill canaplasty for exostosis and osteoma and to evaluate our results. 2) To propose a new grading system for external auditory canal stenosis (EACS). 3) To review the recent literature.

STUDY

DESIGN

A retrospective review.

SETTING

Quarternary referral center for Otology & Skull Base surgery.

SUBJECTS AND

METHODS

Two hundred seventeen patients (256 ears) with exostosis or osteoma were included in the study. Surgical and audiological parameters were evaluated.

RESULTS

Mean age was 51.5 (±13.41) years. One hundred sixty nine cases were men and 48 women. Two hundred forty three (95%) cases were exostosis and 13 (5%) were osteomas. According to the proposed grading system, 81% ears had severe or complete stenosis. Seventy eight (30.5%) ears had a concurrent diagnosis of otosclerosis. Retroauricular approach was used in 245 (95.7%). Intraoperative complications included tympanic membrane (TM) perforation seen in four (2%) and mastoid cell exposure in two (1%). Postoperative stenosis/prolonged healing was seen in 11 (4%) patients and required revision in seven cases. Audiologic analysis available for 153 ears-showed the mean change in air-bone gaps (ABG) of 2.18 dB, pure tone averages (PTA) bone conduction (BC) (0.5-4 kHz) of 0.3 dB. Mean healing rate was available for 246 (96.1%) patients and was found to be 6.35 (4-16) weeks.

CONCLUSIONS

A systematically performed drill canalplasty via retroauricular approach, as described in this article, yields excellent postoperative outcomes as seen in our series. Notably, one-third of exostoses patients in this series, also suffered from otosclerosis. The proposed grading system for EACS enables the surgeon to objectively stage the disease.