What is a Critical Factor for the Re-Canalization of the External Ear Canal?

Background: The incidence of obstruction of the external ear canal (EEC) is very low, and most plastic surgeons have very limited experience in corrective surgery for it. We aim to establish a standard procedure for this corrective surgery. Methods: After a post-auricular incision is made, through which the entire EEC up to the tympanic membrane is exposed, try to excise some tissues (scar tissue, cartilage, and bone tissue) causing obstruction of the EEC. Irrespective of the size of the obstruction, the EEC floor is flattened out. This maneuver requires shaving off a bony portion of the EEC. Finally, a post-auricular cutaneous flap is placed over the defect of the EEC floor. Results: In each case, after the removal of some bony parts, the tympanic membrane and facial nerves remained intact. All flaps successfully covered the defects and survived without any vascular problems. After 2 years of follow-up, the EEC remained patent in all cases. Conclusion: To create an appropriate space for flap placement, it is very important to shave off a bony portion of the EEC. Technically, it is not only easier to make the floor of the EEC straight, but it also serves to prevent re-obstruction.