Our Experience of Treating Wide Spectrum of External Ear Canal Atresia of Different Etiologies in Pediatric Patients

Abstract

External auditory canal atresia (EACA) is a common otologic condition. Etiology can vary from congenital to acquired causes. It causes considerable difficulty to the patient. Bilateral ear canal atresia in children can lead to speech delays due to hearing impairment caused by this condition. Though easily diagnosed it is one of the most difficult conditions to treat. Acquired conditions can affect any age group. Restenosis following treatment is very common. This article focuses on the treatment of EACA due to different etiologies and emphasizes on special points of surgical treatment and follow up. Five cases of external auditory canal atresia was treated between 2014 and 2016. Two of them were congenital cases and three were acquired. One congenital atresia patient had pinna abnormalities in the form of one sided anotia and other side microtia. Another patient of congenital ear canal atresia had congenital cholesteatoma. Acquired atresia was due to osteoma, external trauma and surgical trauma following a condylectomy surgery. All the patients were treated surgically. A wide meatoplasty with split thickness skin graft lining the canal/cavity was done to avoid restenosis. Merocel wicks were used in all cases. Removal of localized granulations on follow up helped keep the canal patent especially in congenital EACA. All patients had significant hearing improvement following surgery. Child with bilateral atresia and pinna anomaly has now achieved normal hearing and speech milestones. She does not use any hearing aid. None of the patients developed restenosis of their reconstructed ear canal. One of the patient developed granulations around the meatoplasty edges which was cauterized using silver nitrate. External auditory canal atresia surgery is a difficult surgery keeping in view the distorted anatomy and the propensity of restenosis of the newly constructed ear canal. Hearing restoration in the operated ear is all the more challenging. Meticulous planning with close discussion with patients and their caregivers regarding multiple surgeries has to be done. Using skin graft, doing a wide meatoplasty, using merocel wicks for ear canal dressing are few important aspects of this surgery which can give satisfactory results in long term.

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