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Postinflammatory medial canal fibrosis: An institutional review and meta‐analysis of short‐ and long‐term outcomes
Author(s) -
Keller Robert G.,
Ong Adrian A.,
Nguyen Shaun A.,
O'Connell Brendan P.,
Lambert Paul R.
Publication year - 2017
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26214
Subject(s) - medicine , meta analysis , confidence interval , restenosis , surgery , stent
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