Widening the ear canal
The procedure to widen the ear canal is called canaloplasty.
- Canal reconstruction surgery is optimally performed through a direct approach along the canal itself. The surgery is normally performed as an outpatient, usually under general anesthesia.
- The surgery may require the removal of the diseased tissue from the entrance of the canal, the superficial soft tissue canal, or the deeper bony section. Concurrent repair of the hearing may be also necessary.
- This reconstruction is performed by creating an opening in the skull where an ear canal would be present and lining the newly created opening with a skin graft. It involves removing the bone to widen the canal and may require a split-thickness skin graft to recover the bone.
- Occluding superficial skin and soft tissues are removed as a small core.
- Then the deeper bone canal obstruction overcomes by drilling away the obstruction down to the eardrum site. Any drum or chain repairs are then performed. The surgeon may be able to manipulate the middle ear bones helping to restore hearing within a normal hearing range (20 dB) or better.
- Fine skin grafts are shaved, usually from the armpit, and are then used to line the new canal completely.
- Canal dressing is left in place for 3 weeks. After removal, the canal is cleaned, and drops are used for a further fortnight at which time the canal is totally healed.
- Once having canaloplasty, hearing can continue to improve anywhere from monthly to well over a year post-op. Most hearing can be improved or restored typically anywhere between 20 dB or better and 35 dB. This is the typical outcome for most patients.
Reason for the procedure: Canaloplasty surgery is undertaken when the entire external canal requires reconstruction to
- Overcome congenital or birth abnormalities.
- Treat external canal disease.
- Treat complications of previous surgery or other situations.
- Remove localized ear canal tumors.
- Fit some specialized forms of hearing aids or for other anatomic purposes.
The causative situation usually results in the absence or destruction of the normal canal skin. Unlike other bodily skin, this tissue has the ability to grow out, along the canal, to self-clean the area. This function is lost if the skin is irreversibly damaged when the canal must be grafted with fine grafts from elsewhere. As a result, fine shedding of the dead skin gradually occurs. This requires occasional cleaning, and the canal should be slightly widened to aerate the site to prevent humidity and infection.
When done alone, the goal of this operation is to widen the ear canal to facilitate cleaning, reduce the number of external ear infections, and prevent wax impaction. This operation is often done in connection with a tympanoplasty and mastoidectomy.
Risks of canaloplasty surgery are as follows:
- Abnormal skin healing
- Pain and infection at the site of surgery
- Abnormal surgical wound healing
- Hearing difficulties
- Ringing in ears
- Facial nerve paralysis
- Eardrum perforation
Depending on the individual and how successful the surgery turned out, a revision surgery (or second surgery) may have to be performed. Keep in mind though that as we age, our hearing naturally degrades.
Recovery: The goal in the reconstruction of the canal and hearing is to deliver the best results with the greatest certainty and minimal distress. However, in surgery, there are no guarantees of success.
- Analgesics will be given both in the hospital and supplied at discharge.
- Antibiotics will be prescribed and provided prior to discharge.
- Rest is very important after the surgery.
- Recovery varies from person to person. Returning to normal activities and work maybe after a few days unless dizziness or other problems intervene.
- The ear canal dressings are removed 3 weeks after surgery, and the ear is reviewed after that.
- Audiology is undertaken at 2 months.
- Subsequent reviews occur on an individual basis. Once having canaloplasty, the patient will have to have their ears cleaned every 6 months to once per year. The newly reconstructed ear canal will tend to slough off the dead skin cells, and these dead skin cells (or debris) will need to be removed to maintain optimal hearing. An ENT surgeon can perform what is called a “deep microscopic” ear cleaning to remove the dead skin cells.