OPERATIONS FOR STENOSIS OF THE EXTERNAL MEATUS
Stenosis, or stricture of the auditory canal, is practically always the result of traumatism or inflammatory conditions; it is only very rarely congenital.
Indications. (i) If there be deafness of the other ear, and the functionally good ear periodically becomes deaf from obstruction of the narrow passage by cerumen or epithelial débris, and the patient is weary of conservative treatment.
(ii) If there be recurrent attacks of otitis externa.
(iii) If there be retention of pus, the result of inflammation of the external or middle ear, which is not relieved by conservative treatment.
The operation is contra-indicated if there is accompanying deafness, due to chronic middle-ear or to internal-ear disease, provided there is no suppuration within the external or middle ear.
Operation. The method of operation depends on whether the stricture is membranous, fibrous, or bony in consistence, or whether it is limited or is causing a general narrowing of the auditory canal. It may take one of the following forms:—
Dilatation. This method is not very satisfactory, and is limited to recent cases of membranous or fibrous stricture of the annular variety. After cleansing the meatus, a small laminaria tent is inserted through the stricture, and if the pain is not too severe it is left in situ for at least twenty-four hours and then withdrawn. The ear is again carefully cleansed, and if possible a larger laminaria tent is substituted. This procedure is repeated until the maximum amount of dilatation has been obtained.
Incision of the stricture. This also is limited to membranous or to fibrous strictures of the annular variety.
The operation, if necessary, may be performed under a local anæsthetic, produced by subcutaneous injections, although usually a general anæsthetic is preferable.