5% 50% 90% 100%

Chapter 6–External Ear, Middle Ear, and Mastoid 冒 83

tained closed fractures of the base of the skull, the skull vault, the
scapula, and 1 rib. The left auricle was severely lacerated. The lining
of the bony EAM was found to be intact. The ear was surgically re-
attached on the day of injury. The patient subsequently had stenosis
develop at the cartilaginous part of the EAM, and he was referred to
the maxillofacial prosthetics department of a university-affiliated
hospital. A conformer was fabricated in a 2-step process. In the first
step, an impression was made of the EAM; this first impression
served to fabricate the definitive conformer. The second impression
was left inside the EAM and served as a preliminary stent before be-
ing replaced by the definitive conformer.

Conclusions.—The advantages of the technique described in this article

are that the definitive conformer is fabricated and inserted on the same day,
which eliminates the need for a provisional conformer. The use of a modeling
plastic impression compound for creating an impression of the EAM pro-
vides an accurate, passive, and air-bubble–free impression of the canal so
that the conformer fits passively in the canal. The smooth surface obtained
by this method also minimizes the risk of bacterial infection of the con-
former. The clear resin conformer is esthetically pleasing to the patient, and
the method described in this article is time efficient, requiring less than an
hour for making and fabricating the impression.

䉴 These authors have described, in effect, an “obturator” to prevent external

auditory stenosis, particularly after correction of congenital atresia and other
procedures for various diseases. Even more important is to use surgical tech-
niques that obviate the need for such an obturator. For example, in correcting
congenital atresia, I will remove cartilage, bone, and soft tissue aggressively
so that, at the time of the procedure, it is more than twice the size of what we
hope for it to be, as the ear would heal, recognizing that it would narrow over
time. Using surgical methods is the best way to keep the meatus open, but, if
need be, an obturator could be an adjunct, as described here.
M. M. Paparella, MD

Squamous Cell Carcinoma of the External Auditory Canal and Middle Ear:
An Operation Combined with Preoperative Chemoradiotherapy and a
Free Surgical Margin
Nakagawa T, Kumamoto Y, Natori Y, et al (Kyushu Univ, Fukuoka, Japan; Aso
Iizuka Hosp, Japan)
Otol Neurotol 27:242-249, 2006 6–6

Objective.—Treatment outcomes for squamous cell carcinoma of the

temporal bone were evaluated regarding stage, therapeutic strategy, and
prognostic factors.
Study Design.—Retrospective case review.
Setting.—University hospital and outpatient clinic.
 5% 50% 90% 100%

84 冒 Otology

Patients.—Twenty-five patients with primary squamous cell carcinoma of

the external auditory canal and middle ear.
Intervention.—Preoperative chemoradiotherapy and radiotherapy were
used in 7 of 12 patients. Lateral temporal bone resection was performed for
the lesions not beyond the tympanic membrane. Subtotal temporal bone re-
section was chosen for lesions extending to the middle ear cavity when there
was no invasion to the pyramidal apex, carotid canal, or dura or metastasis.
Others were conservatively treated by chemoradiotherapy. When the perfor-
mance status was poor or an agreement regarding the operation could not be
reached, the treatment was modified.
Main Outcome Measure.—Estimated survival rates.
Results.—The 3-year estimated survival for T1 and T2 lesions was 100%.
The 5-year estimated survival for T3 and T4 lesions was 80% and 35%, re-
spectively. The 5-year estimated survival improved up to 75% for T4 tumors
with operation and 16% for those without operation after 47 months. The
tumor-free surgical margin is significantly related to patient survival in T3
and T4 lesions. Multivariate analysis predicted that concomitant chronic
otitis media and positive lymph nodes were significantly associated with
poorer survival.
Conclusion.—The tumor-free surgical margin was important to survival.
When T4 lesions did not involve the pyramidal apex, carotid canal, dura, or
any lymph nodes, the surgical intervention improved the estimated survival
rate to a level as good as T3 lesions.

䉴 These authors have a nice series of 25 patients with primary squamous cell
carcinoma of the auditory canal and the middle ear, and they describe their
methods of diagnosis, classification, and treatment of these lesions. They also
describe the role of chemotherapy and radiotherapy in these patients, and, of
course, they emphasize the importance of a tumor-free surgical margin. Cer-
tainly, we would agree with those principles.
M. M. Paparella, MD

Conductive hearing loss and otopathology in cleft palate patients

Goudy S, Lott D, Canady J, et al (Vanderbilt Univ, Nashville, Tenn; Cleveland
Clinic, Ohio; Univ of Iowa, Iowa City)
Otolaryngol Head Neck Surg 134:946-948, 2006 6–7

Objectives.—Assess incidence of conductive hearing loss, ear pathology,

and associated communicative disorders in cleft palate patients.
Study Design.—Retrospective chart review of 101 patients all treated at a
tertiary facility since birth.
Results.—The median patient age was 19 years old (range 8-25) at last
follow-up, 35% female. Median age of cleft palate repair was 16 months
(range 12-60). Median number of myringotomy tubes was 3 (range 1-7).
Conductive hearing loss (CHL) greater than 20 db PTA was found in 25% of
patients at last follow-up. Severity of CHL was mild in 75%, moderate in