Surgical Results of Canalplasty Using a Pedicled Periosteal Flap for External Auditory Canal Cholesteatoma.

Abstract

Objective: We evaluated the outcomes of canalplasty for external auditory canal cholesteatoma (EACC) using an inferior-pedicled periosteal flap to cover the eradicated diseased bone.

Study design: Retrospective chart review.

Setting: Tertiary referral center.

Patients: Thirty-one ears in 30 patients surgically treated for stages III and IV primary EACC.

Intervention: Canalplasty using an inferior-pedicled periosteal flap with or without tympanoplasty.

Main outcome measures: Disease recurrence, hearing, and clinical factors influencing the time taken to achieve complete epithelization of the external auditory canal.

Results: The 31 ears with EACC required 2 to 40 weeks (mean, 7.8 wk; median, 4 wk) to achieve complete epithelization. After epithelization, 84% of the ears became self-cleaning ear canals without any local treatment. Two patients with renal dysfunction experienced recurrence of EACC in the anterior-superior bony canal wall and needed additional treatment. Younger patients took a significantly shorter time to achieve epithelization than older patients (p < 0.001). Patients with renal dysfunction tended to need longer periods for epithelization than those without renal dysfunction (p = 0.092).

Conclusion: Canalplasty for stages III and IV EACC using an inferior-pedicled periosteal flap achieved good postoperative results, with 86% of ears becoming self-cleaning ear canals in a short healing time. Special attention must be paid to the patients with renal dysfunction to create a pedicled flap of sufficient size to cover the bone and maintain a good blood supply.