Hearing Preservation after Lateral Temporal Bone Resection for Early-Stage External Auditory Canal Carcinoma

Abstract

Objective: To evaluate postoperative hearing outcomes after lateral temporal bone resection (LTBR) with reconstruction of the external auditory canal (EAC) and conductive function for early-stage EAC carcinoma. Methods: We retrospectively examined patients diagnosed with early-stage EAC carcinoma treated with surgery alone between January 2006 and December 2012. Patients who had postoperative adjuvant chemotherapy and/or radiotherapy were excluded. Patients receiving LTBR in combination with tympanoplasty were divided into two groups based on the reconstruction of the EAC with and without (w/o) split-thickness skin grafts (STSGs). Audiological data included the preoperative hearing thresholds and the most recent postoperative hearing thresholds obtained at least 12 months after surgery. The hearing outcome was evaluated based on pure-tone audiograms using the Committee on Hearing and Equilibrium guidelines of the American Academy of Otolaryngology-Head and Neck Surgery for the evaluation of the results of treatment of conductive hearing loss. The postoperative quality of life (QOL) for patients was evaluated using the Glasgow Benefit Inventory (GBI). Results: All patients (n = 15) achieved disease-free survival without significant morbidity or mortality. When we compared the mean air-bone gaps after surgery, those in the STSG group (n = 8) were found to be significantly lower than those in the w/o STSG group (n = 7; p < 0.001). The success rate for postoperative hearing was 75.0% in the STSG group, which was significantly higher than that in the w/o STSG group (p = 0.014). All patients in the w/o STSG group showed stenosis and closure of the EAC at fewer than 10 months after surgery. In contrast, all patients in the STSG group showed preserved conformation of the new EAC for more than 12 months after surgery. When we compared the mean GBI score between the two groups of patients, the overall and general health scores in the STSG group were found to be significantly higher than those in the w/o STSG group (p = 0.021, p = 0.001). Conclusions: Reconstruction of the EAC using a rolled-up STSG technique in combination with tympanoplasty after LTBR is useful for hearing preservation and the observation of locoregional lesions after surgery, resulting in improved QOL for patients. i 2014 S. Karger AG, Basel

Physical outcome measures for conductive and mixed hearing loss treatment: A systematic review

“…The titles were initially screened for inclusion resulting in further consideration of 485 publications. After screening of abstracts and then full‐text articles, 153 articles were selected for inclusion …”

Comparison of hearing outcomes after treatment for early‐stage external auditory canal cancer

“…Meanwhile, lateral temporal bone resection resulted in large circumferential skin defects around the external auditory canal and was expected to delay wound healing and epithelialization, causing stenosis because of the formation of scar tissue . Therefore, adequate methods for preventing stenosis and maintaining conformation of the external auditory canal are important for the preservation of hearing ability, with an STSG rolled up onto a local pedicled flap found to provide an opportunity for the promotion of engraftment and epithelialization.…”

“…The ossicle chain was reconstructed with auricular cartilage, which was then set on top of the head of the stapes (type III tympanoplasty), and the temporalis fascia was used to graft a new tympanic membrane. An STSG obtained from the upper thigh was placed circumferentially to constitute the new ear canal, and was laid over the local muscle and periosteal flaps, which were used to form a graft bed …”

“…An STSG obtained from the upper thigh was placed circumferentially to constitute the new ear canal, and was laid over the local muscle and periosteal flaps, which were used to form a graft bed. 13…”

“…Because early‐stage external auditory canal cancers seem to be amenable to the majority of treatment protocols, the prevention of complications involved in the treatment is important. Preservation of hearing ability, in particular, should be considered in selecting the treatment, as hearing impairment has been shown to result in significant cognitive impairment, depression, reduction in functional status, and deterioration in the quality of life (QOL) . However, surgery may exacerbate conductive hearing loss because of postoperative complications, such as chronic infection, bone exposure, stenosis, and closure of the external auditory canal .…”