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| CASE REPORT |
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| Year : 2021 | Volume
: 14
| Issue : 3 | Page : 390-391 |
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A case of acquired external auditory canal stenosis following trauma
Soumick Ranjan Sahoo, Mandira Sarma
Department of ENT, ESIC, Model Hospital, Guwahati, Assam, India
| Date of Submission | 29-Nov-2020 |
| Date of Acceptance | 26-Jul-2021 |
| Date of Web Publication | 30-Sep-2021 |
Correspondence Address:
Dr. Soumick Ranjan Sahoo
T9B Protech Park, Hengrabari Road, Guwahati - 781 036, Assam
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/kleuhsj.kleuhsj_406_20
Acquired external auditory canal (EAC) stenosis is a rare clinical condition. Infection is most common cause which cause acquired EAC stenosis. Trauma is a rare cause. Treatment should be removal of the soft tissue causing the stenosis, doing a canaloplasty, covering the bare areas with skin graft to achieve a patent EAC. We describe a case of the left EAC partial stenosis following road traffic accident 10 years back in which the soft tissue causing the stenosis was surgically removed, canaloplasty was done and bare areas covered with skin graft. The patient has been followed up and no restenosis has occurred. Keywords: External auditory canal, stenosis, trauma
How to cite this article:
Sahoo SR, Sarma M. A case of acquired external auditory canal stenosis following trauma. Indian J Health Sci Biomed Res 2021;14:390-1 |
| Introduction | |  |
Acquired external auditory canal (EAC) stenosis is a rare entity. The main causes are infection, trauma, neoplasia, inflammation, and radiotherapy.[1],[2] The incidence reported in literature is 0. 6 Cases per 100,000 inhabitants by the largest reported series of patients treated for EAC stenosis.[1] The most common cause of acquired stenosis is chronic otitis externa, hence most of the EAC stenosis cases reported in literature are post infectious, post traumatic cases are extremely rare.[3] Whatever may be the cause, treatment of such a condition is difficult and recurrence rate is high. Paparella and Kurkjain introduced the basic surgical principles of excising the fibrous plug, enlarging the cartilaginous and bony canal, and recovering the canal;[4] since then, modifications on this technique have been introduced primarily to prevent the most common postoperative complication, restenosis. Herein, we describe a case of EAC stenosis of the left ear canal which was diagnosed and managed 10 years following RTA.
| Case Report | | |
A 37-year-old male complains of decreased hearing in the left ear since few years. The patient had a history of RTA 10 years back following which he had bleeding from ear and thereafter started having decreased hearing. On ear examination, it was observed that stenosis was present from the entrance of the left EAC. The patient was having moderate conductive hearing loss on audiometry. Computed tomography (CT) temporal bone demonstrated soft tissue density in the left EAC with tiny air foci within it causing stenosis of the left EAC [Figure 1]. Tympanic membrane was retracted. No cholesteatoma was seen and middle ear cavity and ossicles were normal. Preoperative investigations and PAC checkup was done. COVID reverse transcription polymerase chain reaction Test was done which was negative. Soft tissue lesion causing external auditory canal stenosis was surgically excised.Thereafter Canaloplasty was done and the bare areas covered with harvested skin graft. The patient has been followed up and no restenosis has occurred. The patient has shown remarkable hearing improvement. | Figure 1: Computed tomography temporal bone showing soft tissue density in left external auditory canal causing stenosis
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| Discussion | | |
EAC stenosis can have congenital or acquired causes. The most common cause of acquired EAC stenosis is otitis externa. Chronic inflammation of the EAC results in subepithelial infiltration of inflammatory cells; this inflammatory process results in fibrotic changes to the canal,[5] leading to EAC stenosis. Trauma is another possible cause of EAC stenosis. Iatrogenic trauma from prior otologic surgery is a common inciting event;[6] however, direct trauma to EAC is a rare cause of stenosis. Selesnick et al.[7] reviewed 15 reports on this topic and reported that chronic infection was the leading cause of this disorder in 54.1% of the patients, followed by postsurgical (20.2%) and traumatic (11%) causes. The Acquired EAC stenosis can be partial or complete, occurs more in males and is a disorder of young adults. Acquired stenosis can be treated medically or surgically, however, medical management plays a limited role in the treatment of posttraumatic stenosis since the goal of medical therapy is to control the underlying infection and prevent the formation of granulation tissue. Surgery should be the treatment of choice in posttraumatic EAC stenosis. The goal of the surgery is to remove the fibrous plug/debris, widen the bony EAC, expose the tympanic membrane, and recreate an epitheliallined EAC. An important component of EAC stenosis repair following resection of the fibrous plug is a canalplasty, and if necessary, meatoplasty. Any bare area should be covered with skin graft to prevent granulation formation and restenosis.[8]
| Conclusion | | |
Acquired EAC stenosis due to direct trauma is rare and if encountered should be treated surgically by removing the soft tissue causing stenosis, performing a canaloplasty and covering the bare areas with skin grafts so as to achieve a patent EAC.
Compliance with ethical standards
Written Informed consent has been taken from the patient for publication in the journal. The case report has been ethically approved with reference number IEC/ESIC/dt/2020/005.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Becker BC, Tos M. Postinflammatory acquired atresia of the external auditory canal: Treatment and results of surgery over 27 years. Laryngoscope 1998;108:903-7.  |
| 2. | Kumar A, Sarkar A, Kumar S. Post traumatic external auditory canal stenosis causing conductive hearing loss. Astrocyte 2016;3:174-6 |
| 3. | Jacobsen N, Mills R. Management of stenosis and acquired atresia of the external auditory meatus. J Laryngol Otol 2006;120:266-71. |
| 4. | Paparella MM, Kurkjian JM. Surgical treatment of stenosis for chronic stenosing external otitis. Laryngoscope 1966;76:232-45. |
| 5. | Roland PS. Chronic external otitis. Ear Nose Throat J 2001;80:12-6. |
| 6. | McCary WS, Kryzer TC, Lambert PR. Application of splitthickness skin grafts for acquired diseases of the external auditory canal. Am J Otol 1995;16:801-5. |
| 7. | Selesnick S, Nguyen TP, Eisenman DJ. Surgical treatment of acquired external auditory canal atresia. Am J Otol 1998;19:123-30. |
| 8. | Bajin MD, Yılmaz T, Günaydın Rí, Kuşçu O, Sözen T, Jafarov S. Management of acquired atresia of the external auditory canal. J Int Adv Otol 2015;11:147-50. |
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