Postinflammatory medial canal fibrosis: An institutional review and meta-analysis of short- and long-term outcomes

Laryngoscope. 2017 Feb;127(2):488-495. doi: 10.1002/lary.26214. Epub 2016 Aug 31.

Abstract

Objective: Few studies report outcomes of surgical management of postinflammatory medial canal fibrosis (PIMCF). The objectives were to compare short- and long-term outcomes after surgical repair of PIMCF at our institution and systematically aggregate published data for meta-analysis.

Data sources: Medical records for the case series; PubMed, Scopus, and OVID/Medline for the systematic review/meta-analysis.

Methods: Patients undergoing surgical treatment of PIMCF were identified. Short-term (<2 years) and long-term (>2 years) postoperative outcomes were evaluated for the case series and aggregated for the meta-analysis.

Results: At our institution, 16 patients (21 ears) were identified. Compared to the preoperative air-bone gap (ABG) (27.7 ± 7.5 dB), mean postoperative short-term ABG (8.2 ± 7.5 dB) and long-term ABG (15.3 ± 11.3 dB) were significantly improved (P < 0.001 for both). Although short-term restenosis rate was low (0%) among long-term follow-up patients, 64% (9 of 14) experienced some degree of recurrent canal narrowing, including one case of complete restenosis (7%). Similarly, meta-analysis pooled preoperative ABG (29.3 ± 9.7 dB, 95% confidence interval [CI] 27.0-31.6) improved significantly during short-term (11.4 ± 8.0 dB, 95% CI 8.3-4.5, P < 0.0001) and long-term (14.3 ± 9.6 dB, 95% CI 11.6-16.9, P = 0.0004) follow-ups, with partial deterioration in hearing over time. Long-term complete restenosis rate (13.8%) was worse than short-term (8.0%), with no significant difference over time (P = 0.85).

Conclusion: Postinflammatory medial canal fibrosis is a rare condition that can successfully be treated with surgery to restore patency of the external auditory canal. Patients who experience improved hearing early on, however, are at significant risk of restenosis and recurrence of their conductive hearing loss with time.

Level of evidence: N/A. Laryngoscope, 2016 127:488-495, 2017.

Keywords: Medial canal fibrosis; air-bone gap; canaloplasty; external auditory canal; stenosis.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Auditory Threshold*
  • Bone Conduction*
  • Chronic Disease
  • Ear Canal / pathology*
  • Ear Canal / surgery*
  • Female
  • Follow-Up Studies
  • Hearing Tests*
  • Humans
  • Male
  • Middle Aged
  • Otitis Externa / complications*
  • Otitis Externa / pathology
  • Otitis Externa / surgery*
  • Otitis Media, Suppurative / complications*
  • Otitis Media, Suppurative / pathology
  • Otitis Media, Suppurative / surgery*
  • Postoperative Complications / diagnosis
  • Recurrence
  • Skin Transplantation
  • Speech Reception Threshold Test
  • Young Adult