Acquired medial external auditory canal stenosis, anterior tympanomeatal angle blunting, and lateralized tympanic membrane: Nosology, diagnosis, and treatment

Publication date: Available online 11 January 2019

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): A. Karkas, G. Badidi, P. Odinet, P. Reynard, C. Martin

Abstract

Objectives

To analyze the etiologies, auditory consequences, diagnostic tools and therapeutic results of three often confused pathologies: acquired fibrous stenosis of the medial part of the external auditory canal (EAC), fibrous anterior tympanomeatal angle blunting, and lateralized tympanic membrane.

Material and methods

Retrospective study of 18 cases operated on over a 16-year period (14 patients: 7 female, 7 male; aged 11–64 years): 8 cases of medial EAC stenosis, 3 of blunting, and 7 of tympanic membrane lateralization.

Results

In all 3 pathologies, otoscopic and radiologic diagnosis was easily established, so that they could not be confused. All 3 induced > 33 dB conductive hearing loss. Medial EAC stenosis was secondary to chronic inflammation of the EAC, aggravated by surgery in 5 cases. Blunting was secondary to surgery altering the anterior tympanic annulus. Tympanic membrane lateralization was secondary to prior surgery without inflammatory process. Underlying EAC cholesteatoma was found in 3 cases of medial stenosis and in 1 case of blunting. Surgical results were disappointing in medial stenosis, with 62.5% recurrence and mean functional gain of 9 dB, and in blunting, with 66.7% recurrence and mean functional gain of 6 dB; auditory results were, however, good in these 2 pathologies when there was no recurrence of fibrosis. Results were significantly better in lateralized tympanic membrane, with 28.6% recurrence and mean functional gain of 16 dB.

Conclusion

The good results obtained in tympanic membrane lateralization seem to justify surgery in patients bothered by their hearing loss. The indication is more questionable in cases of medial fibrous stenosis and blunting, although significant auditory improvement is achieved in case of surgical success.

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