Transcanal Antrotomy


  • James J. Holt MD

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Marshfield Clinic, Marshfield, Wisconsin, U.S.A.
    • James J. Holt, MD, Department of Otolaryngology–Head and Neck Surgery, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449
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  • Presented at the Middle Section of the Triological Society, Chicago, Illinois U.S.A., January 18–20, 2008.


Objective/Hypothesis: This study describes a transcanal antrotomy technique and highlights its advantages for removal of disease in the tympanum and antrum.

Study Design: Retrospective review of surgical cases using a transcanal antrotomy approach.

Methods: The author's database of major otological procedures was reviewed to identify cases in which a transcanal approach was utilized to remove disease confined to the tympanum-antrum. Cases in which disease progressed into the mastoid, requiring a postauricular approach were excluded. Patient demographics, ear pathology, surgical variables, postoperative variables, and audiometric data were recorded. Standard descriptive statistics were used to summarize demographic and clinical characteristics of study cases. Intraoperative video segments were recorded and edited to depict the operative technique.

Results: Transcanal antrotomy was performed on 47 patients (mean age = 38.7, 51% men, 49% women). Ossicular reconstruction was performed in 27 patients during initial surgery. Sculptured, interposed incus was used in 77.8% of cases. Average intraoperative time was 130 minutes (range = 79–166 min). No major complications occurred postoperatively. Follow-up ranged from 26 to 3,680 days (average = 922 days). No patient had recurrent disease in the antrum. Closure of air-bone gap to within 20 dB occurred in 85% of cases.

Conclusions: Transcanal antrotomy is a safe, efficacious, and minimally-invasive approach to remove disease from the middle ear and antrum. This approach allows for optimal exposure of the antrum and is less invasive than postauricular and endaural approaches. With transcanal antrotomy, second stage procedures can be avoided in many cases resulting in reduced costs and improved quality of life.