Reduction meatoplasty with a post-auricular island flap

A Novel Technique of Reduction Meatoplasty for Correction of Very Large Meatus from a Previous Canal Wall-Down Mastoidectomy

OBJECTIVE

To evaluate the efficacy of reduction meatoplasty, a novel technique aiming to improve the usage of molded hearing aids and ear plugs in patients undergoing mastoid obliteration of a previous canal wall-down (CWD) mastoidectomy, complicated with a very large meatus.

PATIENTS

Twenty-six patients from a tertiary care neurotology clinic with a very large meatus from a previous CWD mastoidectomy, who were unable to use molded hearing aids or ear plugs for water protection.

INTERVENTION

Reduction meatoplasty after mastoid obliteration (cartilage strips and bone pate) of the CWD mastoidectomy. The procedure involves removing a wedge of skin and underlying soft tissue superiorly in the meatus.

MAIN OUTCOME MEASURES

Reduction in meatus size, enabling usage of hearing aids and ear plugs.

RESULTS

Twenty-six patients underwent mastoid obliteration and reduction meatoplasty to reduce meatus size. Patients were followed up for an average of 22 months postoperation. After operation, the meatus size was significantly reduced in all patients, enabling usage of over-the-counter ear plugs. In addition, all six patients with hearing aids could use standard occlusive hearing aid domes without requiring molded hearing aids. No patients showed symptoms of chronic infection in the mastoid cavity during the follow-up period.

CONCLUSIONS

Results of reduction meatoplasty showed significant improvements in functionality of the external auditory meatus, indicating that this technique is effective in reducing meatus size and improving the normal meatal anatomy after mastoid obliteration.

A novel technique C-conchoplasty in canal wall down tympnomastoidectomy

BACKGROUND

Numerous methods for meatoplasty and conchoplasty have been introduced, but no clear V/S(the meatal cavity volume to the cross-sectional) was given and many patients have complained about poor cosmesis on follow-up.

AIMS

To explore the proper size, and cosmetic shape of the external auditory meatus and auditory canal for canal wall-down tympnomastoidectomy (CWD).

MATERIAL AND METHODS

In this observational case series study 36 patients undergone CWD with C-conchoplasty that uses a C-shape skin incision on the concha were reviewed. S and V/S of the preoperative, postoperative and contralateral normal ears were observed. We analyzed the relationship between the epithelialization time and postoperative V/S. Long-term efficacy observation and the shape of the meatus after the operation were observed.

RESULTS

C-conchoplasty could effectively enlarge S and reduce V/S. The postoperative V/S were closer to the normal ear than that if we didn't do C-conchoplasty. The greater difference of V/S between the post-operative ears and the contralateral normal ears, the longer the epithelialization time will be. C-conchoplasty produced an excellent cosmetic result. No other complications were noted.

CONCLUSIONS AND SIGNIFICANCE

The C-conchoplasty, which is a novel and easy technique in CWD, offers good functional and excellent cosmetic results with minimal risk of complications.

The one-cut meatoplasty: novel surgical technique and outcomes

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 2months 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 38.0months, 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.