To the Editor:
In Dr. Longridge's article, “Exostosis of the External Auditory Canal: A Technical Note” (Otol Neurotol 2002;23:260–1), the author makes a good point that removal of the anterior exostosis is the key to long-term patency of the ear canal in these patients. His hesitancy to remove the posterior exostosis with concerns about additional noise trauma to the cochlea; potential injury to the facial nerve/chorda tympani/ossicular chain/tympanic membrane is valid if one is limited to using a drilling technique.
An effective alternative for removal of posterior exostoses is to incrementally shave this lamellar bone with a straight 1-mm osteotome. By using an osteotome technique, the reflected canal wall skin is easily preserved, minimal noise trauma occurs, and the bone comes off in plates, so one gradually enlarges the lumen over a broad surface and poses a lesser risk to the deeper structures. I have used this technique in 52 patients (71 ears) and find that as the posterior exostoses are shaved down, the lateral ear canal opens and the exposure improves when working on the anterior exostosis.
Douglas Hetzler, M.D., F.A.C.S.