Obliterative Exostosis: How to Do It

PROGRAM DESCRIPTION: External ear canal exostosis or surfer's ear is a common disease in our country (Portugal). Besides frequent external otitis, water trapping, and cerumen impaction, obliterative exostosis may cause conductive hearing loss. In our hospital, more than 120 canaloplasties are performed each year. Post-operative results and care are highly dependent on surgical technique and skin preservation. Insufficient calibration of the canal without skin preservation may result in canal stenosis, or demand a longer follow-up period with frequent in-office manipulation of the canal with significant healthcare costs and impact on the patient's quality of life. We aim to share our surgical approach to obliterative exostosis including tips used in different scenarios and share our results. Our surgical planning includes an ear computerized tomography with a description of the exostosis. In obliterative exostosis, we prefer a retroauricular approach. We show how to perform an intracanal incision ("Boomerang" Incision) with minimum damage to the skin and to allow maximum preservation. An eggshell approach is used in the anterior exostosis, sparing the anterosuperior portion to avoid the trauma of the lateral process of the malleus. This portion is removed safely with a curette. A 3 mm and 2mm diamond burrs are used avoiding the need for protecting underlying skin when drilling near the annulus. Skin Flap is repositioned, and an absorbable hemostatic gelatin sponge is placed in the canal. Post-op care is performed for scar evaluation and dressing removal. We will show our results with otoendoscopy images.