Outcomes of drill canalplasty in exostoses and osteoma: Analysis of 256 cases and literature review
Gruppo Otologico, Italy
: J Otol Rhinol
Objectives: To describe the surgical technique of drill canaplasty for exostosis and osteoma and to evaluate our result, to propose a new grading system for external auditory canal stenosis (EACS) and to review the recent literature. Study Design: A retrospective review. Setting: Quaternary Referral Center for Otology and Skull Base Surgery. Subjects & 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 (169) cases were men and 48 women. Two hundred forty three (243; 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. Conclusion: 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.
Golda Grinblat is a Clinical Fellow in Otology, Neurotology and Skull Base Surgery at The Gruppo Otologico, Piacenza, Italy. He is a ENT Specialist at Hillel Yaffe Hospital, affiliated to the Technion University in Haifa, Hadera, Israel.
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