Conchomeatoplasty for chronic otitis externa

Abstract

Chronic moisture is a major cause of chronic otitis externa (COE). Moisture combined with inadequate lubrication of the stratum corneum and retention of keratin debris promote bacterial and fungal growth. In most cases of COE, creating a well-aerated, dry, self-cleaning external auditory canal prevents further infection. This can usually be accomplished by medical treatment that includes suction and swabbing. Antibiotic-steroid ear drops control infection and inflammation. Alcohol flush and warm-air ventilation dry the canal, and a hydrophobic cream lubricates and seals the stratum corneum from moisture, fungus, and bacteria. An anatomic variation, a narrow external auditory meatus leading to poor ventilation, is frequently associated with COE, which does not respond to conventional therapy. A previously unreported simple lateral conchomeatoplasty is presented. No other described meatoplasty corrects both the conchal cartilage projection and inadequate meatal skin circumference which, together, cause the small meatus. The lateral conchomeatoplasty has been used by this author for over 20 years on 35 ears. All patients showed improvement; most had complete control.