Many diseases and traumas lead to the development of narrowing of the external auditory canal. In addition, congenital abnormalities may also be accompanied by an obstruction of the ear canal. Narrowing of the ear canal leads to partial or complete hearing loss. If the narrowing is observed for a long time, infectious processes may develop in the inner ear, which are accompanied by the formation of pus, destruction of the structures of the inner ear, increased intracranial pressure. In order to prevent this, it is necessary to start the treatment of ear canal narrowing as early as possible and perform surgery to widen the ear canal.
There are a great number of conservative methods of treatment in Germany, however, they often require long-term use and do not lead to a positive effect. For surgery, the doctor determines the indications and contraindications. In addition, there are many techniques for performing ear canal dilation, so the doctor will be able to determine the necessary volume and tactics of the operation only after a preliminary examination and inspection. In German ENT clinics, more than a dozen ways of eliminating the narrowing of the ear canal have been developed. The following methods are the main and radically eliminating constrictions:
— Schwarze’s way. The standard access for this surgery is the posterior surface of the ear drum. After the incision, the doctor cuts away the tissues to remove a part of the external ear canal in thin layers with a chisel. Access to the inner ear is then gained. Further, in the place where the overgrowth occurred, several incisions are made, overgrown tissues are removed and a flap is formed, which is pressed with a tampon. Then the wound is sutured.
— Rultin’s way. This method is longer and consists of several steps. After making an incision behind the ear, a drainage tube corresponding to the size of the normal ear canal is sewn to the wounds. Next, the scar tissue is removed, which gives access to the canal where the drainage tube is inserted. The tube is attached with the help of skin, forming a stalk. After a week, the tube is completely removed, and further, according to the results of the examination and observation in one or two weeks, the stem is cut.
— Neumann’s way. The difference of this method is the use of the area of the goiter as two flaps, and the second one — the mastoid process. The base of the first flap is located almost on the fossa, after the formation of scar tissue, the flap is placed inside the ear canal. Formation of the second flap is performed by cutting the skin and periosteum, this leads to the opening of one of the walls of the ear canal. The wall is then removed or dislodged depending on certain indications. The second flap is the most important, as it forms the three walls of the ear canal.
— The Preobrazhensky way. The peculiarity of the method is the one-stage formation of a wide flap, which is divided into several parts. These parts are then used to form the walls of the ear canal.
— Proskuryakov’s way. The operation involves several stages. First, a cuff is formed. To do this, a drainage tube is placed on the flap extracted from the lobe and the skin is sutured on top of the tube. After gaining access to the canal, a chisel is used to widen the narrowing. The next stage of the operation is to fill the passage with plastic material. Form a flap on the pedicle by making several incisions. The formed flap is placed in the lumen of the ear canal. Then the wound is sutured.
— Hilov’s way. The first stage of the operation is practically the same as other techniques. Subsequently, an incision is made almost up to the auricle. In addition, with this technique, another incision is made, perpendicular to the first one. With the help of incisions, the doctor forms two triangular flaps. Thanks to these flaps, a wide cavity of the ear canal is created. The entire cavity is filled with a stency mass, which solidifies when cooled, creating an impression of the cavity. Once the impression is obtained, a flap is created, which is taken from the thigh or shoulder. It is placed in the area of the impression. The wound is completely sutured one week after the cast is removed.
— Transmastoidal approach. The tympanic cavity is dilated and a gap is formed between the tympanic cavity and the auditory ossicles. In the postoperative period, 4% Na-CMC gel is applied, which contributes to a long-lasting and persistent effect.
These techniques are used not only for anomalies of the external auditory canal, but also as a complex surgery for hearing loss and destruction of the auditory ossicles.
Unfortunately, there are several disadvantages of these techniques. When flap techniques are used, stenosis may develop, as well as granulations and lateralization of the neotympanic membrane.
Therefore, to minimize the risk of complications as much as possible, a qualified and highly specialized ENT doctor and modern high-tech equipment are required when performing surgical ear canal dilation. Only such a specialist will be able to choose the right ear canal dilation method for you and determine the indications for it.
Our Munich clinics are staffed by ENT professors who are renowned in Europe and beyond for their achievements in the successful treatment of patients with this pathology, and who have helped many, many of our patients in close cooperation with us.
It should also be emphasized that ear canal enlargement surgery requires joint work of an otolaryngologist and a plastic surgeon both at the planning stage of the operation and during its performance. Our ENT specialists have such a complex and individual approach to each patient.