Blind Sac Closure of the External Auditory Canal in Temporal Bone Surgery: Long-Term Results

To report long-term results in patients who underwent blind sac closure (BSC) of the external auditory canal (EAC) for middle ear or skull base diseases, as part of subtotal petrosectomy (SP), performed either as a stand-alone procedure or in combination with cochlear implantation or lateral skull base approaches.

A retrospective single-center cohort observational study was conducted on patients who underwent SP with BSC of the EAC between January 2015 and December 2022. Risk factors for BSC-related complications were considered, including preoperative EAC conditions (i.e., mal-formations, previous meatoplasty or previous BSC), surgical cavity status (i.e., active infection, cerebrospinal fluid (CSF) leak and dural opening), and presence of cochlear implant (CI).

Overall, 158 cases of SP with BSC of the EAC were analyzed, with a mean follow-up time of 49.6 months (range 6-102). Of these, 67 underwent SP alone, 55 SP with simultaneous CI surgery, and 36 SP in the context of lateral skull base approaches. Risk factors related to BSC were identified, including 23 previous meatoplasties, 12 previous BSC, 2 malformations of the EAC, 29 active infections, 37 cases of CSF or dural opening, and 56 CIs. A single case of BSC dehiscence requiring revision surgery was observed.

Analysis of surgical outcomes specifically related to BSC of the EAC in the context of SP, either as a stand-alone procedure or combined with cochlear implantation or lateral skull base approaches, showed an extremely low rate of complications in the short and long term.