Chronic ear surgery in irradiated temporal bones

OBJECTIVE: To analyze outcomes of chronic ear surgery in patients with irradiated temporal bones. STUDY DESIGN: Retrospective case review. METHODS: Fifteen patients who received radiation involving the temporal bone underwent 21 surgical procedures from 1977 to 1997. Intraoperative findings, long-term complications, and hearing outcomes were analyzed. RESULTS: Over 50% of cases involved abnormal intraoperative findings including facial nerve dehiscence, labyrinthine fistulas, or dural exposure. Audiologic data revealed that these patients suffered from conductive, mixed, and sensorineural hearing loss. Long-term complications included tympanic membrane perforation and recurrent cholesteatoma. All patients had dry, non-draining ears at the end of the study. CONCLUSIONS: Irradiated temporal bones present difficult intraoperative anatomy and often require multiple procedures to cure otologic disease. Although radiation significantly reduces vascularity and hampers healing, vascularized reconstruction flaps are not necessary for good outcomes.