Surgery for external auditory canal exostoses and osteomata

Abstract

The popularity of water sports in Western Australia results in a high demand for surgery for meatal exostoses when compared to Europe or North America, and such procedures for advanced exostoses present a technical challenge.We report on a decade of experience in exostosis and osteoma surgery consisting of 127 procedures on 102 patients. Exostectomy was an access manoeuvre for other otological procedures in 13 cases and five procedures were for regrowth of exostoses. Minor complications were seen after 22 per cent of operations. Major complications were experienced after five per cent for example canal stenosis, temporomandibular joint prolapse, sensorineural loss, persistent deep bony lip and persistent tympanic membrane perforation. There were no facial palsies.Exostosis surgery should be reserved for failed conservative treatment and attention focused on adequate access, meatal skin preservation and tympanic membrane protection. An approach which concentrates on safe anterior landmarks and wide exposure is recommended to avoid serious complications.

Surgery for External Auditory Canal Exostoses: A Report of 182 Operations

“…Sheehy [5], for example, reported tympanic membrane perforations in 12 patients (14%), temporary canal narrowing in 4 patients (5%) and a permanent mild EAC stenosis in 1 patient. In the study by Fisher and McManus [6], 5% of the patients had a major complication (2 EAC stenosis, 1 temporomandibular joint prolapse, 1 tympanic membrane perforation and 1 sensorineural deafness).…”

“…In California, the incidence of 0.6% has been calculated for EAC exostoses, and they are more common in males [2]. According to centres with large experience with this problem, the primary treatment of EAC exostoses is conservative, and surgery should be reserved for those with symptoms [5][6][7].…”

Chondroma of the bony external auditory canal attached to the short process of the malleus

“…These complications tend to occur when the lesion is large. According to Fisher and McManus [10], asymptomatic benign osseous tumor in the ear canal does not need removal. Therefore, chondroma of the ear canal may be observed and excised only when it causes symptoms.…”

Prevalence of External Auditory Canal Exostoses in Surfers

“…In the case of severe disease in which recurrent otitis externa and long-term hearing impairment exists, surgery is indicated and is generally successful. 17,18 Fisher and McManus 17 report that major complications, including canal stenosis, temporomandibular joint prolapse, sensorineural loss, persistent deep bony lip, and persistent tympanic membrane proliferation occurred in 5% of 127 exostectomy procedures that their group performed. Although they did not report any facial palsies, Green and colleagues 19 report a 14% incidence of facial nerve injury during exostoses removal.…”