title: Medial canal fibrosis: surgical technique, results, and a proposed grading system.
abstract: OBJECTIVE
  To report the hearing and surgical results in patients with medial canal fibrosis. To describe the surgical technique for removal of medial canal fibrosis and to propose a classification for grading postoperative surgical outcome and to correlate this with hearing results.
  
  
  METHODS
  Tertiary university referral center.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Twenty-one patients with mature medial canal fibrosis underwent a total of 26 operations at our institution from February 1994 to June 2003. Four patients underwent surgery for bilateral disease and another had a second operation for recurrence.
  
  
  RESULTS
  According to the proposed grading system, 10 (38.5%) of the 29 ears operated on achieved a Grade I result (normal self-cleaning ears) and three (11.5%) had recurrence (Grade III). One patient was found to have external ear canal cholesteatoma. Postoperatively, 15 ears demonstrated closure of the air-bone gap to within 10 dB or improvement on four-frequency average pure-tone audiogram to better than 25 dB. The mean preoperative air-bone gap was 28.7 dB compared with 12.5 dB postoperatively (p < 0.001). When hearing results were correlated with postoperative grade, 90.0% of the ears with a Grade I result had significant hearing improvement, 46.2% in patients with Grade II and 33.3% in patients with Grade III results. Four patients complained of temporomandibular joint pain postoperatively.
  
  
  CONCLUSIONS
  Surgery remains the treatment of choice for mature medial canal fibrosis. With proper surgical technique and meticulous postoperative care, a patent and functioning external ear canal can be achieved in a majority of patients. Absence of recurrence does not equate with improved hearing thresholds.
authors.affiliation: Department of Otolaryngology, Sunnybrook and Women's College Health Science Center, Toronto, Ontario, Canada. vlin@sympatico.ca
authors.forename: Vincent Yu-Wen
authors.initials: VY
authors.lastname: Lin
authors.forename: Gerard H
authors.initials: GH
authors.lastname: Chee
authors.forename: Eytan A
authors.initials: EA
authors.lastname: David
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001299:Audiometry; D018424:Cholesteatoma, Middle Ear / Q000150:complications; D015331:Cohort Studies; D004424:Ear Canal / Q000473:pathology* / Q000601:surgery*; D004427:Ear Diseases / Q000145:classification / Q000150:complications / Q000601:surgery*; D005260:Female; D005355:Fibrosis; D006314:Hearing Loss, Conductive / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D013506:Otologic Surgical Procedures; D011183:Postoperative Complications / Q000145:classification; D012008:Recurrence; D012189:Retrospective Studies; D016038:Skin Transplantation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation; D014433:Tympanoplasty