{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:19:46Z","timestamp":1791274786205,"version":"4.1.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acquired external auditory canal stenosis (EACS) is a major cause of conductive hearing loss in children and adults, with multiple etiologies including otological surgical procedures, blunt trauma, and chronic inflammatory diseases, which can lead to persistent hearing loss and other adverse outcomes. Due to children's unique anatomical fragility and strong tissue proliferative capacity, the clinical management of EACS remains challenging.This study aims to explore the clinical characteristics, optimal surgical approaches and prognostic factors of traumatic EACS in children, so as to provide evidence-based references for clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective medical record review was conducted for patients diagnosed with EACS who received treatment at The Second Xiangya Hospital between November 2020 and November 2025. Data were collected regarding age, gender, etiology, clinical symptoms, surgical methods, and postoperative outcomes. Descriptive statistics and Fisher's exact test were used for data analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The findings indicated that the characteristics of EACS in children were unilateral involvement (100%), with the primary etiologies being associated with prior ear surgeries (86%) and isolated hearing loss (100%). The postoperative recurrence rate was 57%, and all recurrent cases were accompanied by restenosis. In pediatric surgeries, the temporoparietal fascial flap was the most frequently utilized graft (43%), 43% of patients underwent conchal cartilage resection, and 86% received absorbable drug\u2014eluting stent (DES) implantation. All patients adhered to a unified DES implantation and postoperative care protocol. Type I tympanoplasty (Wullstein classification) was carried out in one pediatric case and one adult case for tympanic membrane repair. The adult cohort exhibited multiple etiologies (50% related to prior ear surgeries, 17% post\u2014trauma, 25% post\u2014inflammation), frequent accompanying symptoms (25% with tinnitus, 50% with otorrhea, 17% with earache), a recurrence rate of 25%, and no postoperative restenosis. Statistical analysis verified that the restenosis rate in pediatric patients was significantly higher than that in adults (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.012), and there was no significant correlation between recurrence and flap selection, cartilage resection, or DES implantation (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study tentatively indicates that there exist disparities in the clinical characteristics of acquired external auditory canal stenosis between children and adults. The risk of postoperative restenosis in children is notably elevated, and this tendency might be associated with the inherent anatomical fragility and robust tissue proliferation capacity in children. Comprehensive preoperative imaging assessment, individualized surgical plan development, standardized drug\u2014eluting stent implantation, structured long\u2014term postoperative follow-up, and postoperative care may be conducive to enhancing the prognosis of acquired external auditory canal stenosis in children. Multicenter prospective studies with a larger sample size are required to further validate the optimal treatment strategy for acquired external auditory canal stenosis in children.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1814290","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T05:35:23Z","timestamp":1778736923000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Acquired external auditory canal stenosis: clinical characteristics, surgical strategies and prognostic analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"CaiYun","family":"Meng","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, The Second Xiangya Hospital of Central South University","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruosha","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, The Second Xiangya Hospital of Central South University","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"WeiJing","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, The Second Xiangya Hospital of Central South University","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, The Second Xiangya Hospital of Central South University","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"B1","first-page":"365","article-title":"Postinflammatory acquired atresia of the external auditory canal: late results of surgery","volume":"7","author":"Tos","year":"1986","journal-title":"Am J Otol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1975","DOI":"10.1097\/00005537-200211000-00012","article-title":"External auditory canal stenosis after radiation therapy","volume":"112","author":"Carls","year":"2002","journal-title":"Laryngoscope"},{"key":"B3","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.anorl.2018.12.002","article-title":"Acquired medial external auditory canal stenosis, anterior tympanomeatal angle blunting, and lateralized tympanic membrane: nosology, diagnosis, and treatment","volume":"136","author":"Karkas","year":"2019","journal-title":"Eur Ann Otorhinolaryngol Head Neck Dis"},{"key":"B4","doi-asserted-by":"publisher","first-page":"6624","DOI":"10.3390\/ijerph17186624","article-title":"Risk of acquired cholesteatoma and external auditory canal stenosis in traumatic brain injury: a nationwide population-based cohort study","volume":"17","author":"Lin","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"B5","doi-asserted-by":"publisher","first-page":"147","DOI":"10.5152\/iao.2015.461","article-title":"Management of acquired atresia of the external auditory canal","volume":"11","author":"Bajin","year":"2015","journal-title":"J Int Adv Otol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1017\/S0022215106000272","article-title":"Management of stenosis and acquired atresia of the external auditory meatus","volume":"120","author":"Jacobsen","year":"2006","journal-title":"J Laryngol Otol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/MAO.0000000000000667","article-title":"Modified meatoplasty for external auditory canal stenosis with endoaural-conchal incision","volume":"36","author":"Chen","year":"2015","journal-title":"Otol Neurotol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1258\/0022215041917808","article-title":"Canalplasty for severe external auditory meatus exostoses","volume":"118","author":"Sanna","year":"2004","journal-title":"J Laryngol Otol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1452","DOI":"10.1097\/MLG.0b013e3181753354","article-title":"To POP or not: ossiculoplasty in congenital aural atresia surgery","volume":"118","author":"Dobratz","year":"2008","journal-title":"Laryngoscope"},{"key":"B10","doi-asserted-by":"publisher","first-page":"73","DOI":"10.17305\/bjbms.2022.7676","article-title":"Acquired atresia of the external auditory canal and canaloplasty with thiersch graft reconstruction: outcomes and complications","volume":"23","author":"Pace","year":"2023","journal-title":"Biomol Biomed"},{"key":"B11","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1111\/j.1365-2273.1978.tb00724.x","article-title":"Tympanoplasty: the fundamentals of the concept","volume":"3","author":"Wullstein","year":"1978","journal-title":"Clin Otolaryngol Allied Sci"},{"key":"B12","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1016\/j.anl.2020.06.006","article-title":"The impact of middle ear aeration on surgical outcome after intact canal wall tympanoplasty for cholesteatoma","volume":"47","author":"Motegi","year":"2020","journal-title":"Auris Nasus Larynx"},{"key":"B13","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/j.bioactmat.2024.05.035","article-title":"Biomedical application of materials for external auditory canal: history, challenges, and clinical prospects","volume":"39","author":"Xu","year":"2024","journal-title":"Bioact Mater"},{"key":"B14","doi-asserted-by":"publisher","first-page":"2265","DOI":"10.1016\/j.ijporl.2015.10.019","article-title":"Transcanal endoscopic ear surgery for pediatric population with a narrow external auditory canal","volume":"79","author":"Ito","year":"2015","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1177\/0194599811426257","article-title":"Long-term stent use can prevent postoperative canal stenosis in patients with congenital aural atresia","volume":"146","author":"Moon","year":"2012","journal-title":"Otolaryngol Head Neck Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1097\/MAO.0b013e3182015f27","article-title":"Revision aural atresia surgery: indications and outcomes","volume":"32","author":"Oliver","year":"2011","journal-title":"Otol Neurotol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1016\/j.otc.2023.06.012","article-title":"Acquired stenosis of the external ear canal","volume":"56","author":"Mankekar","year":"2023","journal-title":"Otolaryngol Clin North Am"},{"key":"B18","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1016\/j.amjoto.2017.03.015","article-title":"Morphological characteristics of external auditory canal in congenital aural stenosis patients","volume":"38","author":"Yin","year":"2017","journal-title":"Am J Otolaryngol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2325967118760190","DOI":"10.1177\/2325967118760190","article-title":"Articular cartilage repair of the knee in children and adolescents","volume":"6","author":"Salzmann","year":"2018","journal-title":"Orthop J Sports Med"},{"key":"B20","first-page":"Doc01","article-title":"Reconstruction of middle ear malformations","volume":"6","author":"Schwager","year":"2007","journal-title":"GMS Curr Top Otorhinolaryngol Head Neck Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1007\/s12070-017-1145-y","article-title":"Our experience of treating wide Spectrum of external ear canal atresia of different etiologies in pediatric patients","volume":"69","author":"Bhavana","year":"2017","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e313","DOI":"10.1097\/PRS.0b013e3181bf83f1","article-title":"Pediatric free-tissue transfer","volume":"124","author":"Upton","year":"2009","journal-title":"Plast Reconstr Surg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1007\/s12070-015-0890-z","article-title":"Modified radical mastoidectomy with type III tympanoplasty: revisited","volume":"68","author":"Goyal","year":"2016","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1016\/j.wneu.2020.10.169","article-title":"Temporoparietal fascia flap endonasal transposition in skull base reconstruction: surgical technique","volume":"146","author":"Arosio","year":"2021","journal-title":"World Neurosurg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1016\/j.otohns.2008.08.028","article-title":"Clinical characteristics of external auditory canal cholesteatoma in children","volume":"139","author":"Yoon","year":"2008","journal-title":"Otolaryngol Head Neck Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1097\/00005537-199806000-00021","article-title":"Postinflammatory acquired atresia of the external auditory canal: treatment and results of surgery over 27 years","volume":"108","author":"Becker","year":"1998","journal-title":"Laryngoscope"},{"key":"B27","doi-asserted-by":"publisher","first-page":"830","DOI":"10.1002\/lary.1986.96.8.830","article-title":"Surgical treatment of stenosis of the external auditory canal","volume":"96","author":"McDonald","year":"1986","journal-title":"Laryngoscope"},{"key":"B28","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1017\/S0022215100140150","article-title":"Acquired medial canal fibrosis","volume":"112","year":"1998","journal-title":"J Laryngol Otol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1177\/00034894241312142","article-title":"Novel use of drug-eluting stent in otologic surgery to prevent restenosis","volume":"134","author":"Karasik","year":"2025","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1007\/s00405-007-0314-0","article-title":"Topical treatment of acute otitis externa: clinical comparison of an antibiotics ointment alone or in combination with hydrocortisone acetate","volume":"264","author":"M\u00f6sges","year":"2007","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1177\/0194599813514365","article-title":"Clinical practice guideline: acute otitis externa","volume":"150","author":"Rosenfeld","year":"2014","journal-title":"Otolaryngol Head Neck Surg"},{"key":"B32","first-page":"0510","article-title":"Otitis externa","volume":"2015","author":"Hajioff","year":"2015","journal-title":"BMJ Clin Evid"},{"key":"B33","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1177\/0145561320922117","article-title":"The effect of external auditory canal packing duration on healing after endoscopic cartilage myringoplasty","volume":"100","author":"Lou","year":"2021","journal-title":"Ear Nose Throat J"},{"key":"B34","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1017\/S0022215108002661","article-title":"Expansile properties of otowicks: an in vitro study","volume":"122","author":"Clamp","year":"2008","journal-title":"J Laryngol Otol"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1814290\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T05:35:29Z","timestamp":1778736929000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1814290\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,14]]},"references-count":34,"alternative-id":["10.3389\/fped.2026.1814290"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1814290","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,14]]},"article-number":"1814290"}}