Pinch skin grafting for idiopathic inflammatory medial meatal fibrotizing otitis

Abstract

Objectives: Idiopathic inflammatory medial meatal fibrotizing otitis is an uncommon disorder of the external auditory canal characterized by desquamation of the medial canal skin, chronic inflammation, and eventual canal stenosis. Medical treatment consists of regular debridement, topical and systemic steroids, and antimicrobials for acute infections. Surgical treatment of canal stenosis by removal of the fibrotic plug followed by split thickness skin grafting has been reported. However, skin grafting of the canal prior to development of complete stenosis has not been reported. Methods: Case report of a 72-year-old male hearing aid user who was referred for a 7-month history of recurrent external otitis and subsequent stenosis of the external auditory canals. On physical exam, he had erythema, granulation tissue, and synechia in the medial external auditory canals bilaterally. Treatment consisted of regular debridements, external canal wicks, high potency topical steroids, oral steroids, ear powder, and systemic and topical antibiotics. After 20 months of medical treatment, the external canals remained patent but failed to epithelialize. Pinch skin grafts from the posterior auricular area were applied to the medial canal tissue in the office under local anethesia. Results: After 6 weeks, the skin grafts have become adherent to the medial canal tissue and are beginning to epithelialize the canal. There has been no further stenosis. Conclusion: Pinch skin grafting in medial meatal fibrotizing otitis is a promising technique for restoring the epithelium in this chronic condition. The long-term viability of the epithelium and the affect on disease progression deserves further investigation.