Thiersch graft follow-up with narrow band imaging for acquired atresia of the external auditory canal: Canaloplasty with Thiersch graft versus vascularization evaluated with narrow band imaging

Acquired atresia of the external ear canal (EAC) is defined as a narrowing caused by abnormal production of soft or bony tissue. EAC has two different phases, a wet one and a dry one. A computed tomography (CT) scan may show images where the soft tissue fills the EAC. Treatment with CT may be medical and/or surgical. The surgical technique most widely adopted is canaloplasty with a skin free flap. To the best of our knowledge, no previous article has reported data analyzing the vascularization of acquired atresia of the EAC and vascularization of the skin flap during follow-up with narrow-band imaging (NBI). This paper aimed to study post-surgical vascularization of the skin graft, with NBI endoscopy, to identify any eventual areas with less perfusion that may lead to degeneration and fibrosis. Patients suffering from acquired atresia of the external auditory canal, surgically treated in the Department of Organi di Senso of Sapienza University, from 2017 to 2020 were enrolled. All patients underwent anamnestic collection, physical examination, and mastoid CT. Pre- and post-operative otoendoscopic evaluations (at 1, 3, 6 and 12 months) were performed with both cold white light (CWL) and NBI endoscopic vision. 17 patients were enrolled in the study. Pre-operative otoendoscopic examination of CWL showed stenosis with a diameter <75% and a tympanic membrane not viewable in all patients. At 12 months of follow-up, 94% of patients had no recurrence of EAC stenosis. 88% of patients presented an adequate vascularization by NBI. Our study aimed to evaluate whether the NBI endoscopic view and the analysis of vascularization may be useful for improving the prognosis of patients surgically treated with canaloplasty and Thiersch graft for acquired atresia of EAC, concerning the single analysis using CWL endoscope.