Canaloplasty and Exostosis Removal Comparing Microscopic Versus Endoscopic Ear Surgery Techniques

By June 7, 2019

Sayyid,Z.1; Vaisbuch, Y1; Sajjadi, A.2; Sajjadi, H.1
1 Stanford University Department of Otolaryngology-HNS
2 Creighton University School of Medicine

Canaloplasty of the external ear canal is usually performed to treat narrowing or blockage that may lead to cerumen impaction, recurrent infections and conductive hearing loss. This procedure can be done microscopically or endoscopically.

– Study Design: retrospective case review
– Setting: private and tertiary referral centers
– Patients: 26 patients that were treated by the same surgeon between 2003-2019; 96% male; average age at time of surgery: 50 years
– Intervention(s): Trans-canal canaloplasty, exostosis and osteoma removal

– Main Outcome Measure(s)
: post-operative healing, hearing improvement, and complications in microscopic versus endoscopic technique
– Results:
13 cases (11 patients) were performed endoscopically and 19 cases (15 patients) were performed using only the microscope. There were no significant differences in patient demographics. No major complications were identified in any of the procedures including facial nerve palsy, sensorineural hearing loss, complications of anesthesia, or death. The change between pre-op and post-op audiometric tests did not significantly differ (p > 0.05). Significantly fewer minor complications including residual or recurrent exostosis or stenosis, infection, post-operative bleeding, and poor wound healing were noted in endoscopic cases (30.8%) as compared to microscopic cases (73.7%) (p = 0.02). Poor wound healing and granulation tissue were noted in 11 (57.9%) microscopic cases, 4 of which required revision with skin grafting. No endoscopic cases required revision with skin grafting.

Using an endoscope via a transcanal approach allows for better outcomes in regard to post-operative complications. This finding may be explained due to an improved view of the end of the instruments while maintaining this minimally invasive approach.