gms | German Medical Science

Introduction: Connections between the external acoustic meatus and the mastoid process may occur after trauma or surgery. A spontenous development without any „middle ear history“ as in our patient is unusual and can mean a therapeutical challenge.

Patient: A 28-year-old patient reported a whistling and squeezing sound out of his right ear while blowing his nose. Surgery was performed twice without success. So far he had never had problems with his ears before.

During otoscopy there were no pathological findings in the external auditory canal and ear drum. However, performing the Valsalva-manoeuvre revealed a bubble like lesion at the posterior wall oft he cartilgenous part of the meatus.

The HRCT demonstrated a extensively pneumatised mastoid with a small defect of the posterior wall of the external auditory meatus. Twice the attempt was made to close the fistula before: the first time cartilage was used and the second time bone wax. Both interventions were unsuccessful. It was discussed to create a canal wall down technique which would have meant a large cavity in this young patient.

We decided to close the defect with a large periosteal flap after a retroauricular approach in combination with a grommet to avoid any pressure increase in the mastoid after surgery. The postoperative course was uneventful and the fistula remained closed.

Conclusion: Spontenous connections between the mastoid and the external auditory meatus are unusual and need an individual therapy as shown in this case. The goal is to achieve a stable closure with a minimal amount of surgical trauma.