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Acquired external auditory canal stenosis: clinical characteristics, surgical strategies and prognostic analysis
CaiYun Meng1, Ruosha Lai1, WeiJing Wu1
1Department of Otolaryngology, Head and Neck Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
Insights
Pediatric acquired external auditory canal stenosis (EACS) shows higher restenosis rates than adults, often linked to ear surgeries. Optimized care, including imaging and drug-eluting stents (DES), may improve outcomes for EACS in children.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Engineering
Background:
- Acquired external auditory canal stenosis (EACS) causes conductive hearing loss due to surgery, trauma, or inflammation.
- Managing EACS in children is challenging due to their unique anatomy and tissue healing.
- Understanding EACS in pediatric populations is crucial for improving hearing outcomes.
Purpose of the Study:
- To investigate clinical characteristics of traumatic EACS in children.
- To identify optimal surgical approaches for pediatric EACS.
- To determine prognostic factors for EACS treatment in children.
Main Methods:
- Retrospective review of EACS patients treated between November 2020 and November 2025.
- Data collected on demographics, etiology, symptoms, surgical methods, and outcomes.
- Descriptive statistics and Fisher's exact test used for analysis.
Main Results:
- Pediatric EACS was unilateral, primarily caused by ear surgeries, and resulted in hearing loss.
- Pediatric patients had a 57% recurrence rate with restenosis, significantly higher than adults (25%).
- Temporoparietal fascial flaps and drug-eluting stent (DES) implantation were common in pediatric cases; no correlation found between recurrence and specific surgical techniques.
Conclusions:
- Significant differences exist in EACS clinical characteristics between children and adults.
- Children face a higher risk of postoperative restenosis, potentially due to anatomical factors.
- Individualized surgical plans, standardized DES implantation, and long-term follow-up are recommended for pediatric EACS management.
Background:
Acquired external auditory canal stenosis (EACS) is a major cause of conductive hearing loss in children and adults, with multiple etiologies including otological surgical procedures, blunt trauma, and chronic inflammatory diseases, which can lead to persistent hearing loss and other adverse outcomes. Due to children's unique anatomical fragility and strong tissue proliferative capacity, the clinical management of EACS remains challenging.This study aims to explore the clinical characteristics, optimal surgical approaches and prognostic factors of traumatic EACS in children, so as to provide evidence-based references for clinical practice.
Methods:
A retrospective medical record review was conducted for patients diagnosed with EACS who received treatment at The Second Xiangya Hospital between November 2020 and November 2025. Data were collected regarding age, gender, etiology, clinical symptoms, surgical methods, and postoperative outcomes. Descriptive statistics and Fisher's exact test were used for data analysis.
Results:
The findings indicated that the characteristics of EACS in children were unilateral involvement (100%), with the primary etiologies being associated with prior ear surgeries (86%) and isolated hearing loss (100%). The postoperative recurrence rate was 57%, and all recurrent cases were accompanied by restenosis. In pediatric surgeries, the temporoparietal fascial flap was the most frequently utilized graft (43%), 43% of patients underwent conchal cartilage resection, and 86% received absorbable drug-eluting stent (DES) implantation. All patients adhered to a unified DES implantation and postoperative care protocol. Type I tympanoplasty (Wullstein classification) was carried out in one pediatric case and one adult case for tympanic membrane repair. The adult cohort exhibited multiple etiologies (50% related to prior ear surgeries, 17% post-trauma, 25% post-inflammation), frequent accompanying symptoms (25% with tinnitus, 50% with otorrhea, 17% with earache), a recurrence rate of 25%, and no postoperative restenosis. Statistical analysis verified that the restenosis rate in pediatric patients was significantly higher than that in adults (P = 0.012), and there was no significant correlation between recurrence and flap selection, cartilage resection, or DES implantation (all P > 0.05).
Conclusion:
This study tentatively indicates that there exist disparities in the clinical characteristics of acquired external auditory canal stenosis between children and adults. The risk of postoperative restenosis in children is notably elevated, and this tendency might be associated with the inherent anatomical fragility and robust tissue proliferation capacity in children. Comprehensive preoperative imaging assessment, individualized surgical plan development, standardized drug-eluting stent implantation, structured long-term postoperative follow-up, and postoperative care may be conducive to enhancing the prognosis of acquired external auditory canal stenosis in children. Multicenter prospective studies with a larger sample size are required to further validate the optimal treatment strategy for acquired external auditory canal stenosis in children.
