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Partial medial canal fibrosis.

A 31-year-old woman presented with chronic drainage from the left ear. Her condition had not resolved with oral and topical antibiotics.

The otoscopic appearance of the left eardrum was similar to that seen in a case of tympanic membrane perforation, but the pathology was much more lateral and the eardrum could be visualized through the circumferential fibrotic tissue involving the ear canal (figure 1). Findings on audiometry and tympanometry of the left ear were normal. Computed tomography (CT) of the temporal bone demonstrated the fibrotic tissue band lateral to the tympanic membrane (figure 2). The patient underwent surgery, the fibrotic tissue was removed, and a canaloplasty was performed.


Medial canal fibrosis is more common in females than males, and it may be seen at any age. Among the causative factors that have been implicated are chronic infection, hearing aid use, and surgical trauma. Over time, chronic inflammation leads to the formation of granulation tissue in the ear canal, and the granulation eventually matures into dense fibrotic tissue.

A careful physical examination is of utmost importance in establishing the diagnosis. In patients with complete medial canal fibrosis, the external ear canal appears to be shortened by a skin-covered barrier that may resemble a lateralized tympanic membrane. Findings on the physical examination will vary according to the degree of severity in cases of partial fibrosis. CT is useful for evaluating the extent of the pathology.

Suggested reading

Birman CS, Fagan PA. Medial canal stenosis--Chronic stenosing external otitis. Am J Otol 1996:17:2-6.

el-Sayed Y. Acquired medial canal fibrosis. J Laryngol Otol 1998:112: 145-9.

Slattery WH III, Saadat R Postinflammatory medial canal fibrosis. Am J Otol 1997:18:294-7.

Adrien A. Eshraghi, MD; S. Arif Ulubil, MD

From the University of Miami Ear Institute, Department of Otolaryngology, University of Miami Miller School of Medicine.
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Article Details
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Author:Ulubil, S. Arif
Publication:Ear, Nose and Throat Journal
Article Type:Brief Article
Date:Feb 1, 2006
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