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Abstract

Background:

Meatoplasty is a surgical procedure that is used to treat chronic ear conditions such as chronic otitis media, cholesteatoma, and external auditory canal stenosis. Despite its widespread use, there is a lack of comprehensive analysis of the effectiveness of different meatoplasty approaches and their long-term outcomes. This systematic review aims to systematically analyze the existing studies to evaluate the effectiveness of meatoplasty and its approaches with a focus on surgical outcomes, postoperative complications, and patient satisfaction across diverse surgical approaches and patient demographics.

Methods:

The searches from databases like PubMed and Google Scholar for studies on meatoplasty in chronic ear surgeries from 2010 to 2024. Seventeen studies were selected based on predefined inclusion criteria, focusing on success rates, complications, and long-term outcomes. Data were extracted on patient demographics, surgical techniques, and outcomes, and the quality of evidence was assessed using the Newcastle Ottawa Scaleand the Cochrane risk of bias assessment tool.

Results:

The analysis of the included studies revealed diverse patient populations and varying meatoplasty approaches for treating chronic ear conditions. Most studies reported positive outcomes, with significant improvements in ear dryness, hearing, and symptom relief. Postoperative complications, such as meatal stenosis and granulation tissue, were rare and manageable, while the long-term follow-up was crucial for preventing restenosis. However, meatoplasty proved effective in restoring ear canal function, with both one-cut and Z-plasty techniques showing favorable results.

Conclusion:

Advancements in meatoplasty and related surgical techniques have shown great success in managing chronic ear conditions, alleviating symptoms, enhancing hearing, and improving overall quality of life. Their effectiveness is evident in high graft success rates and low complication rates, with innovative approaches and careful postoperative care effectively managing rare issues like stenosis, ensuring favorable long-term results.

Keywords

meatoplasty chronic ear condition chronic otitis postoperative complications hearing improvement

Introduction

Meatoplasty is a surgical technique designed to enlarge the external auditory canal (EAC) and facilitate the formation of a skin flap for neocavity epithelialization. It plays a critical role in open-cavity tympanomastoidectomy procedures and surgeries involving stenosis of the EAC.¹ Often performed as an adjunctive phase, meatoplasty is incorporated into canalplasties, tympanoplasties, and various other otoneurological surgeries. The reconstruction of the new meatus involves manipulation of skin, cartilage, subcutaneous tissue, and bone. The specific surgical planes are determined by the underlying pathology, the primary procedure being performed, and the required diameter of the external opening. Conditions commonly necessitating meatoplasty include suppurative chronic otitis media (COM), cholesteatomatous COM, congenital or acquired EAC stenosis, refractory infections, traumatic damage, neoplastic growths, and iatrogenic injuries.^2,3

Meatoplasty plays a vital role in the functional restoration of the ear and enhances the effectiveness of open-cavity procedures, making it a cost-effective option for the management of cholesteatomas.⁴ A sufficiently wide meatal opening ensures easy access to the auditory canal, tympanic membrane, and open neocavities, while also reducing the need for intensive postoperative care.^5–7 Based on clinical experience, open-cavity tympanomastoidectomy combined with meatoplasty is recommended for cholesteatoma treatment, as it provides functional outcomes comparable to those achieved with closed techniques.^8,9 Moreover, maintaining proper ventilation of the ear canal or cavity—facilitated by meatoplasty—is essential for preventing otorrhea, particularly in tropical climates where activities like swimming are common and may increase the risk of epithelial desquamation, granulation tissue formation, and fungal infections.^10,11

Although functional rehabilitation through meatoplasty offers significant advantages, long-term follow-up is crucial to prevent postoperative complications. Infections, particularly otorrhea, can occur.^12,13 Postoperative infections may occur within the reconstructed open cavity—which includes the EAC, attic, and mastoid in canal wall down (CWD) procedures. These infections are better described as postoperative cavity infections rather than acute mastoiditis, given the loss of anatomical separation. Therefore, regular follow-up and patient education on preventing infections and maintaining clean ear canals are essential for achieving the final goals of hearing loss care. However, in some cases, other procedures may be necessary to combat recurring issues, such as canal restenosis or persistent otorrhea,^14,15 it is essential to provide comprehensive care and patient education to ensure successful outcomes.

While meatoplasty is commonly used in chronic ear surgeries, there is a lack of knowledge about the success, failure, and complication rates, based on various approaches of meatoplasty. Previous studies have focused on the benefits of open-cavity tympanomastoidectomy and the significance of adequate ventilation, but a few comparative studies were published in assessing the outcomes of meatoplasty in the prevention of chronic ear conditions. Meatoplasty is most commonly indicated in chronic inflammatory ear conditions, particularly chronic suppurative otitis media (CSOM) and cholesteatoma. Although it is also performed in cases of acquired EAC stenosis, trauma, or congenital anomalies, these are only considered in this review when the indication overlaps with chronic disease or functional impairment requiring long-term canal patency and drainage. Thus, the purpose of this systematic review is to determine the outcomes, success rates, and complication profiles associated with different meatoplasty techniques when performed alone or as an adjunct to tympanoplasty, canaloplasty, and mastoidectomy in chronic ear surgeries and to identify effective management approaches to enhance long-term results.

Methodology

Search study

To execute this systematic review and literature search, the most recent articles and abstracts that are accessible through paid databases, based on the success rates of meatoplasty, were considered prioritized using Google Scholar, PubMed, and Science Direct. The terms were carefully selected from the 2010 to 2024 studies in the literature search to obtain comprehensive results. These keywords include “Meatoplasty” AND “chronic ear surgeries,” “Meatoplasty” AND “tympanomastoidectomy” AND “COM,” “Meatoplasty success” OR “success rates of meatoplasty” AND “chronic ear surgeries,” AND “postoperative complications” OR “otorrhea,” “Meatoplasty” AND “canal stenosis” OR “long-term outcomes,” and “Open-cavity tympanomastoidectomy” AND “cholesteatoma.”

Selection criteria

The studies that focused on patients who underwent various types of chronic ear surgeries, including tympanomastoidectomy, canaloplasty, modified radical mastoidectomy, ossiculoplasty, cochlear implantation, and other otoneurological procedures requiring meatoplasty were selected. Studies were assessed based on the following predefined inclusion and exclusion criteria to ensure the relevance and quality of the evidence.

Inclusion criteria

Only full-text articles published in peer-reviewed journals between 2010 and 2024 were included in this review. Clinical studies, clinical trials, observational studies (cohort and cross-sectional), and randomized controlled trials (RCTs) were eligible for inclusion. Studies were included to determine whether they reported success rates of meatoplasty, postoperative complications (e.g., otorrhea, infections), long-term outcomes, functional recovery, or prevention of canal stenosis. Only cases where meatoplasty was performed in the context of chronic disease management (e.g., CSOM, cholesteatoma, acquired EAC stenosis with recurrent otorrhea) were included. Studies with mixed etiologies, such as congenital and acquired were eligible if: (i) outcome data for the chronic disease subgroup were reported or could be extracted; or (ii) the cohort explicitly included chronic disease-related cases even if not stratified.

Exclusion criteria

Articles published in languages other than English were excluded to avoid translation errors and ensure accurate data interpretation. Studies with abstracts or full texts containing unclear or ambiguous information regarding key outcomes, such as success rates or complications related to meatoplasty were also excluded. Non-clinical studies, including animal studies, in vitro research, or laboratory-based investigations, were deemed ineligible. Furthermore, articles that were not peer-reviewed, unpublished, or presented as conference abstracts with insufficient detail were excluded. Studies focused on canaloplasty for congenital anomalies unrelated to chronic ear disease or procedures in other specialties (e.g., ophthalmology, urology) were excluded. Additionally, articles that did not address chronic ear conditions requiring meatoplasty, such as non-chronic ear infections or cosmetic ear surgeries, were not considered.

Data extraction

The data for this systematic review were extracted from peer-reviewed articles published between 2010 and 2024. The primary data included findings on the success rates of meatoplasty in chronic ear surgeries, complications associated with different approaches, and surgical outcomes such as postoperative hearing improvement, canal stenosis prevention, and infection control. Key data points extracted were sample size, demographic details (e.g., gender distribution, age range), underlying conditions, preoperative symptoms, surgical interventions performed, follow-up durations, and postoperative outcomes. Relevant statistical data, including complication rates, success percentages, and long-term maintenance requirements were also documented.

To enhance the consistency and comparability of data across the included studies, key clinical outcomes were operationally defined for this review. This approach allowed for the standardized evaluation of surgical success and complications, given the variability in reporting across the literature. Surgical success was defined using a combination of objective and subjective measures. Specifically, success was considered present if one or more of the following criteria were met: (1) achievement of a dry ear, characterized by the absence of persistent otorrhea or discharge during the postoperative follow-up period; (2) maintenance of meatal patency, reflected by an adequately sized and epithelialized EAC with no evidence of restenosis; (3) hearing improvement, particularly a measurable reduction in the air-bone gap (ABG), with an ABG closure of ⩽20 dB considered clinically significant; (4) graft success, indicated by an intact tympanic membrane graft without perforation or medialization; and (5) patient-reported satisfaction, including improved comfort, cosmetic outcomes, and facilitation of hearing aid use, where applicable. Postoperative complications were categorized as minor or major based on their severity and the need for further intervention. Minor complications included granulation tissue formation, transient otorrhea, mild hyperemia, and temporary cosmetic deformities such as a cupped ear. These were typically self-limiting or manageable with conservative measures. Major complications, in contrast, involved more significant adverse outcomes such as meatal stenosis requiring surgical revision, persistent infection or discharge unresponsive to medical therapy, flap necrosis, and cholesteatoma recurrence. The need for revision meatoplasty or additional reconstructive procedures was also considered a major complication.

Quality assessment

We use the Newcastle-Ottawa Scale¹⁶ to assess the quality of non-randomized studies, as it evaluates key domains such as selection, comparability, and exposure/outcome to determine the risk of bias. For RCTs, we apply the Cochrane Risk of Bias assessment¹⁷ to evaluate the reliability of the studies by examining factors like random sequence generation, allocation concealment, blinding, and handling of incomplete data.

Results

The 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were employed to identify, screen, assess, and include studies for this systematic review on the success rates of meatoplasty approaches in chronic ear surgeries (Supplemental Table 1).¹⁸

Search results

The systematic search identified a total of 1450 records. After duplicate removal (n = 401) and automation-assisted exclusion of irrelevant records (n = 168), 881 records were screened for eligibility. Of these, 367 articles were excluded due to being older than 14 years, written in languages other than English, or irrelevant to the scope of the study. A total of 514 studies were assessed for eligibility, of which 497 were excluded due to incomplete data or a non-clinical nature. Ultimately, 17 studies meeting the inclusion criteria were included in this review (Figure 1).

Figure 1.

PRISMA flow chart for article selection.

The demographic characteristics of the included studies

The reviewed studies explore a range of surgical and conservative treatments for conditions impacting the EAC and middle ear. These conditions include COM, congenital and acquired EAC stenosis or atresia, cholesteatoma, and related disorders. Patient ages range from young children to older adults, with follow-up durations extending from weeks to several years. Surgical interventions frequently discussed include various types of meatoplasty, tympanoplasty, mastoidectomy, and canaloplasty, each tailored to the specific condition being treated. When described, conservative treatments often involve antibiotics, corticosteroids, and aural toileting. The outcomes and follow-up data emphasize the long-term effectiveness of these treatments, with an analysis of surgical techniques, gender distributions, and patient outcomes based on underlying conditions.

The included studies comprised 1 RCT, and 16 prospective/retrospective studies accounted for the majority (93.8%). This predominance reflects the observational nature of research in this field. Collectively, the studies included a total sample size of 824 patients, illustrating a broad range of patient demographics and surgical methodologies (see Table 1).

Table 1.

The demographic characteristics of included studies.

Study name	Study type	Study period	Sample size	Gender distribution	Age of patients	Underlying conditions	Conservative treatments	Surgical interventions	Follow-up duration
Hovis et al.⁵	Retrospective chart review and patient questionnaire study	January 2009–February 2013	36	15 women out of 28 patients	Median: 39.5 years (range: 6–82 years)	COM with cholesteatoma (86%), without cholesteatoma (14%), allergic rhinitis, sinusitis, diabetes, malignancy, smoking	Not explicitly mentioned	CWD tympanomastoidectomy with one-cut meatoplasty (indications: ICW recurrence, bony canal erosion, labyrinthine fistula, etc.)	Mean: 38.0 months (range: 14.1–61.6 months)
Chen and Zhang¹⁹	Retrospective clinical study	2003–2010	140	Not mentioned	Not mentioned	EAC stenosis	None mentioned	Modified meatoplasty with endoaural-conchal incision	Average: 20.8 ± 16.6 months (range: 2.2–55.7 months)
Chen et al.²⁰	Retrospective cohort study	January 2016–August 2018	58	MAT group: 46.4% male; TF group: 51.6% male	MAT: mean 63.2 years; TF: mean 65.8 years	COM with tympanic membrane perforation	Not mentioned	Tympanoplasty with MAT graft (28 ears) versus TF graft (31 ears)	Mean: 4.6 months
Zafar and Kumar²¹	Prospective clinical study	January 2020–December 2021	50	30 males (60%), 20 females (40%)	Age range: 12–24 years; Mean: 17.78 years (SD: 3.6)	COM (unsafe type) with suspicion of cholesteatoma	None mentioned	Modified radical mastoidectomy followed by meatoplasty	1 year
Gumban and Almazan²²	Randomized controlled trial	February–July 2009	19	Group A: 5 males, 6 females; Group B: 4 males, 6 females	Group A: mean 30.09 years; Group B: mean 31.00 years	CSOM	Modified meatoplasty and Z meatoplasty following postauricular open mastoidectomy in patients with CSOM	Group A: modified meatoplasty; Group B: Z meatoplasty	4 weeks
Abdulrahman²³	Retrospective study	2016–2018	234	127 males, 107 females	Mean: 26.5 years (8–60)	CSOM	Aural toileting, dressing with antibiotics (27.4%)	Tympanoplasty (77.1%), tympanoplasty + meatoplasty (6.5%), mastoidectomy (4.3%)	Not mentioned
Fu et al.²⁴	Retrospective study	2009–2018	76	52 males, 24 females	Mean: 12.53 years (4–31)	Congenital aural stenosis, microtia	None	Modified meatoplasty, autologous cartilage microtia reconstruction, tympanoplasty, ossicular chain reconstruction	Mean: 4.68 years (1–9)
Carnevale et al.²⁵	Retrospective study	2011–2019	7	4 males, 3 females	Mean: 46.8 years (28–71)	COM, cholesteatoma	None	Partial mastoid obliteration with cartilage palisade reconstruction, cochlear implantation, multi-layered closure of incision	Mean: 4.5 years (3–7 years)
Guo et al.²⁶	Retrospective study	2018–2023	11	9 males, 2 females	Mean: 32 years (24–48)	Acquired EAC stenosis or atresia	Triamcinolone acetonide injections, dilation therapy (silicone tube insertion)	Meatoplasty with free skin flap grafting, retroauricular incision for atresia, scar tissue removal	Mean: 15.4 months (4–57 months)
Mantsopoulos et al.²⁷	Retrospective study	2006–2020	34	17 males, 17 females	Mean: 55.2 years (20–79 years)	Chronic suppurative otitis media, chronic myringitis, or skin disease of the EAC	Not specified	Tympanomeatoplasty (13 cases), meatoplasty (28 cases), bony canaloplasty, split-thickness skin grafting (anterior and posterior walls of the ear canal)	Mean: 18 months (12–48 months)
Kara et al.²⁸	Prospective cohort	2019–2021	28	Male: 46.4%, female: 53.6%	Mean: 36.14 years	COM	None	CWD mastoidectomy with meatoplasty or obliteration	6 months
Nagaoka et al.²⁹	Retrospective chart review	Aug 2002–July 2009	9	5 male, 4 female	8–64 years (avg. 33)	Congenital and acquired EAC stenosis	None	Inferiorly based retroauricular flap meatoplasty with EAC widening and tympanoplasty	5–14 years (avg. 8.4)
Suker et al.³⁰	Prospective study	March 2010–October 2010	34	24 males (70.6%), 10 females (29.4%)	9–40 years	CSOM, cholesteatoma, mucosal disease	Pre- and post-surgical antibiotics and ear drops	Tympano-mastoidectomy: CWD (23 patients), intact canal wall (11 patients); meatoplasty performed during CWD procedures by excising conchal cartilage	8 months
Diarra et al.³¹	Retrospective and prospective study	November 2020–October 2023	34	24 males, 10 females	7–80 years (mean: 35.31 years)	Chronic cholesteatomatous otitis media	Not specified	Open tympanoplasty (81.25%), closed tympanoplasty (17.64%), ossiculoplasty, meatoplasty	6 months
Stultiens et al.³²	Retrospective cohort	2007–2011	72	50% male, 50% female	7–71 years	Chronic inflammation of EAC; acquired atresia	Not specified	Wide meatoplasty with skin grafting, fibrous plug removal, use of silicone sheets, and hydrocortisone/oxytetracycline/polymyxin B ear ointment	0.2–3.7 years
Sonvane et al.³³	Prospective and retrospective observational study	May 2019–December 2021	20	11 males, 9 females	Mean age: 42.9 years; range: 0–60 years	CSOM	Not specified	Revision CWD mastoidectomy	3+ years
Shady et al.³⁴	Retrospective cohort	January 2021–2023	48	26 males, 22 females	Mean: 55.2 31.1	CSOM	Not specified	Fisch and corner-tag meatoplasty techniques after canal wall down tympanomastoidectomy	1 year

The main findings of the included studies

Preoperative symptoms

Preoperative symptoms commonly reported across studies include chronic ear discharge, highlighted by Zafar and Kumar,²¹ Diarra et al.³¹ and Sonvane et al.³³ Hearing loss was a predominant symptom noted by Hovis et al.⁵ Abdulrahman,²³ Fu et al.²⁴ Carnevale et al.²⁵ Guo et al.²⁶ Mantsopoulos et al.²⁷ Kara et al.²⁸ Suker et al.³⁰ Diarra et al.³¹ Stultiens et al.³² and Sonvane et al.³³ Otalgia was reported by Abdulrahman,²³ Suker et al.³⁰ and Sonvane et al.³³ while cholesteatoma was noted by Zafar and Kumar,²¹ Gumban and Almazan,²² and Kara et al.²⁸ EAC stenosis was highlighted by Chen and Zang,¹⁹ Fu et al.²⁴ Mantsopoulos et al.²⁷ and Nagaoka et al.²⁹ Tympanic membrane perforation was specifically reported by Chen et al.²⁰ Additionally, severe complications, including abscesses and meningitis, were described by Gumban and Almazan²² (Table 2).

Table 2.

The main findings of the included studies.

Study name	Preoperative symptoms	Postoperative outcomes	Antibiotic regimen	Steroid therapy	Histological findings	Surgical features	Postoperative care	Complications	Long-term maintenance	Hearing improvement
Hovis et al.⁵	Chronic ear disease symptoms: drainage, hearing loss, and advanced otologic disease	Mean CES: 78.6 ± 2.6; Subscales: activity restriction: 72.6 ± 3.8, symptoms: 76.3 ± 2.3, medical resource utilization: 90.5 ± 2.2	NR	NR	NR	One-cut meatoplasty: avoided the inferior cut for better healing and cosmesis	28.6% self-cleaning; 32.1% 6-month cleaning; 39.3% yearly cleaning	1 case (3.6%) meatal stenosis; no facial palsy, hearing loss, or cerebrospinal fluid leak	The majority required little maintenance; routine cleaning sufficed	7 hearing aid users, none reported difficulty with hearing aid fitting, discomfort, or feedback
Chen and Zhang¹⁹	EAC stenosis	Patients were satisfied with the effect	5–7 days of postoperative antibiotics	NR	NR	Endoaural-conchal incision, local rotation flaps, transposition split-thickness scalp flaps, tympanic membrane reconstruction	Ribbon gauze dressing removed after 4 weeks, cotton ball in canal for 6 months, follow-up every 3 months	Restenosis in 2 cases (1.38%); no severe complications	Stable outcomes without significant maintenance issues	NR
Chen et al.²⁰	TM perforation	Graft success: MAT: 92.9%; TF: 90.3%	Antibiotic-soaked gel foam used	NR	MAT: rich collagen fibers, and glands; TF: dense collagen fibers	Transmeatal approach, MAT is harvested from areolar tissue, with no external incisions	Weekly follow-up for 1 month; no mastoid bandage required	None reported	Stable graft results with minimal maintenance	ABG improvement: MAT: 5.4 dB; TF: 3.4 dB
Zafar and Kumar²¹	Chronically discharging ear, suspicion of cholesteatoma	Comparable outcomes between groups	NR	NR	Not applicable	Single cut: Incision in conchal cartilage; Conchomeatoplasty: Cartilage excision, superior/inferior skin flaps	1-year follow-up examinations	Granulation (3 cases in Group 2, treated with chemical cautery using 20% silver nitrate solution); Cosmetic defect of pinna due to large-sized meatoplasty (1 case in Group 2)	Stable outcomes: wide meatus maintained for aeration, debridement, and drainage	NR
Gumban and Almazan²²	Chronic ear discharge, cholesteatoma, abscesses, meningitis	Hyperemia: higher in Z meatoplasty (90%) versus modified meatoplasty (36.4%) in week 1; narrowing of the canal: higher in modified meatoplasty (72.7%) versus Z meatoplasty (20%) in week 2	Chlorhexidine acetate or tobramycin gauze dressing used	NR	Not applicable	Modified meatoplasty: 12 o’clock incision, no conchal cartilage removal; Z meatoplasty: Conchal cartilage excision, Z-flap sutures	Weekly evaluations for hyperemia, discharge, granulation tissue, and canal narrowing	Hyperemia: higher in Z meatoplasty; narrowing: higher in modified meatoplasty	Stable outcomes after 4 weeks	NR
Abdulrahman²³	Hearing loss (97.4%), Otalgia, ear discharge	Dry ear (majority), improved hearing thresholds	Topical antibiotics	NR	NR	Temporalis fascia, fascia lata, cartilage grafts (conchal, tragal)	Graft monitoring, hearing tests	Persistent ear discharge, facial nerve palsy, infection, dizziness	Long-term dry ear in most patients	Significant improvement in hearing thresholds
Fu et al.²⁴	Conductive hearing loss, stenotic EAC	Serviceable hearing in 68.4% (ABG < 30 dB), improved aesthetics of auricle	Intravenous antibiotics for infections	NR	NR	Modified meatoplasty with endoaural-conchal incision; Nagata auricular reconstruction method	Zero-pressure technique for skin flap, high-pressure oxygen therapy, protective ear cover	Skin flap necrosis (3 patients), framework absorption (3 patients), aural stenosis (2 patients), recurrent cholesteatoma in infected cases	Maintained EAC health and auricle shape in most cases	Significant improvement in hearing in most patients (68.4%)
Carnevale et al.²⁵	Hearing loss, stable mastoid cavity	No infections, no recurrence of cholesteatoma	Ciprofloxacin-soaked sponges	NR	NR	Cartilage multi-layered palisade reconstruction, double-layered flap closure	Pressure dressing, meticulous suture, long-term follow-up	Cable extrusion (1 patient), requiring revision surgery on the contralateral side	Stable mastoid cavity and maintained cochlear implant position	Improved hearing in all cases, except extrusion-related revision
Guo et al.²⁶	Ear fullness, hearing loss, ear bleeding	Unobstructed auditory canal, well-epithelialized surgical sites, no restenosis	NR	Local injections of triamcinolone acetonide suspension	NR	Retroauricular incision, skin grafting, drainage tube placement	Regular follow-up, tube maintenance for 3 months, re-insertion of dislodged tubes	Scar formation in 1 patient, resolved with steroid and dilation therapy	Prevented restenosis with continuous expansion and follow-up procedures	Improved in all cases post-surgical intervention
Mantsopoulos et al.²⁷	Conductive hearing loss, ear canal restenosis	ABG significantly improved (short-term: 65.8% achieved ⩽20 dB; long-term: 50%	NR	Not applied	Dense keloid-like fibrosis in 73.3% of cases, lichenoid inflammation, ectopic ceruminous glands, hyperkeratosis, and cholesteatoma in 46.6%	Split-thickness skin grafts were placed on ear canal walls; bony canaloplasty performed to widen the medial ear canal	Silicone strips to stabilize grafts; Gelfoam ear packing; clinical monitoring for restenosis	29.3% revision surgery rate, restenosis in 40.9% of long-term cases	Surgical removal of fibrotic plug, broadening of medial ear canal	Short-term ABG: 15.5 ± 10.1 dB, long-term ABG: 19.4 ± 10.8 dB
Kara et al.²⁸	Hearing loss, wet ear, visible cholesteatoma	Improved QoL, intact tympanic membrane in 92.9%–100% of cases, dry ears	NR	NR	Not applicable	Bone dust for obliteration, cartilage grafts	Routine EAC hygiene, regular checkups	21.4%–57.1% EAC debris accumulation (group dependent)	Regular cleaning for hygiene	Pre- and postoperative ABG reduction observed
Nagaoka et al.²⁹	EAC stenosis, difficulty in local treatment	Significant improvement in 8 cases, no change in 1 case	NR	NR	Not applicable	Inferiorly based retroauricular pedicle flap; flap tunneled under the conchal bowl and sewn to EAC	Antibiotic-soaked gauze packing removed after 1 week	Recurrence of medial fibrosis (1 case), otorrhea (1 case), and keloid (1 case)	Stable results in most cases with good canal patency	Hearing improvement in cases with tympanoplasty or successful control of discharge
Suker et al.³⁰	Aural discharge (100%), hearing loss (100%), otalgia (2.9%)	67.6% (23/34) achieved dry ears; 32.4% (11/34) remained with discharging ears; CWD had better outcomes	Oral and topical antibiotics	NR	Not applicable	CWD meatoplasty: posterosuperior conchal cartilage removed, cavity packed with BIPP	Regular dressing changes; daily observation during hospitalization, and follow-up every 1–8 months	32.4% failure rate (discharging ears)	Follow-up ensured proper healing and evaluated dryness	No significant improvement; the ABG worsened postoperatively
Diarra et al.³¹	Chronic otorrhea (94.6%), hyperacusis	Otorrhea is absent in 88.23%, with no stenosis of meatoplasty	Yes, for all patients	NR	Cholesteatoma with keratinizing squamous epithelium	Open and closed tympanoplasty; cartilage grafts for ossicular repair	Routine postoperative care	2 facial paralysis cases, 1 persistent tinnitus, 1 vertigo case	Routine monitoring; no loss of canal patency	Hearing preserved/improved in 91.17%
Stultiens et al.³²	Conductive hearing loss, chronic external otitis	Significant improvement in air conduction by 18 dB; closure of ABG ⩽ 20 dB in 83% of cases (short-term), sustained improvement in 77% of cases (long-term)	Hydrocortisone/oxytetracycline/polymyxin B	Topical steroid in ear ointment	Presence of fibrous plugin EAC	Postauricular approach, careful canaloplasty, wide meatoplasty to align meatus with EAC, skin grafting to avoid restenosis	Regular cleaning of EAC to prevent infection, tight packing with silicone sheets, strict follow-up protocol	Granulation tissue formation, recurrence in 8% of cases	Frequent outpatient visits for cleaning; maintenance of ventilation and prevention of infections	Improvement in air conduction; ABG closure within 20 dB in majority of cases (short- and long-term)
Sonvane et al.³³	Persistent ear discharge, hearing loss, earache, tinnitus, vertigo, facial asymmetry	Improvement in most cases, though 2 had worsened hearing outcomes; persistent disease in some cases	NR	NR	Residual/recurrent cholesteatoma, osteitis	Narrow meatoplasty, high facial ridge, residual cholesteatoma, inadequate saucerization of the cavity, and incomplete removal of the buttress	Frequent cleaning of the cavity, long-term follow-up, and regular debris removal	Persistent drainage in some cases due to granulation or inadequate surgical correction	Continued monitoring and periodic cavity inspection	Hearing improvement was observed in 75% of cases; ABG closure (0–30 dB)
Shady et al.³⁴	Non-complicated unsafe chronic suppurative otitis media	Only one patient in each group developed wound infection and none in both groups developed perichondritis. Two patients in group B (Corner-Tag) compared to only one patient in group A (Fisch) had granulations on the meatal incision. One patient of group A needed revision meatoplasty. Group B needed more time for epithelization than Group A also resulted in wider mean new meatus in Group B than in Group A	Topical antibiotics	Intradermal steroids	NR	Canal Wall Down (CWD) tympanomastoidectomy via a postauricular approach; Fisch or Corner-Tag techniques	All patients in both groups were monitored closely postoperatively, with daily follow-up during the first week, weekly follow-up throughout the first month, and quarterly visits for up to 1 year. Follow-up assessments focused on identifying wound infections, monitoring the duration of healing and epithelialization, and evaluating the presence of granulation tissue or suture displacement. Additional parameters included the development of hypertrophic scars or keloids, measurement of the new meatal diameter, detection of canal stenosis requiring revision meatoplasty, and assessment of the auricle’s shape to determine any cosmetic concerns	Only one patient in each group developed wound infection and none in both groups developed perichondritis. Two patients in group B compared to only one patient in group A had granulations on the meatal incision. One patient of group A needed revision meatoplasty	All patients in both groups were monitored closely postoperatively, with daily follow-up during the first week, weekly follow-up throughout the first month, and quarterly visits for up to 1 year	NR

NR: not reported; TM: tympanic membrane; CES: Canal Endoscopic Scale; EAC: external auditory canal; CSOM: chronic suppurative otitis media; MAT: meatal areolar tissue; TF: temporalis fascia; CWD: canal wall down; ABG: air-bone gap; COM: chronic otitis media.

Postoperative outcomes and complications

Postoperative outcomes were generally positive, with the majority of patients experiencing significant improvement in hearing thresholds, dry ear status, and symptom resolution. Significant hearing improvements were reported in multiple studies, such as Abdulrahman²³ observed improved thresholds, and Stultiens et al.³² noted an 18 dB air conduction improvement with ABG closure ⩽20 dB in 83% of cases (short-term). Fu et al.²⁴ highlighted serviceable hearing (ABG < 30 dB) in 68.4% of patients. These findings underscore the efficacy of surgical interventions in restoring functional hearing.

The majority of studies highlighted the achievement of dry ears as a key outcome, with Abdulrahman²³ and Suker et al.³⁰ reporting dry ears in 67.6% of patients. Furthermore, Diarra et al.³¹ emphasized the absence of otorrhea in 88.23% of cases. Similarly, Kara et al.²⁸ reported intact tympanic membranes in 92.9%–100% of cases, accompanied by dry ears and improved QOL. These results reflect the success of surgical procedures in improving both physical and QOL outcomes for patients.

Additionally, high graft success rates, as reported by Chen et al.²⁰ (meatal areolar tissue (MAT): 92.9%; TF: 90.3%), and Fu et al.²⁴ noted improvements in auricle aesthetics. Surgical sites were well epithelialized with no restenosis in Guo et al.²⁶ although Mantsopoulos et al.²⁷ observed restenosis in 29.3% of cases. Minimal surgical complications were reported overall, with Carnevale et al.²⁵ noting no infections or cholesteatoma recurrence, and Zafar and Kumar²¹ reported no perichondritis or stenosis, despite a few cases of granulation or cosmetic defects.

Hovis et al.⁵ reported that meatal stenosis occurred in 3.6% of cases, while no cases of facial nerve palsy or cerebrospinal fluid leaks. Granulation tissue formation was noted in a few studies,²¹ where patients required chemical cautery to manage the issue. These complications were generally manageable and did not significantly affect the overall success of the surgery. Moreover, the incidence of severe complications like hearing loss or infections was low. Together, these results suggest the overall safety and effectiveness of surgical approaches, with limited complications and substantial patient benefit (Table 2).

Histological findings and surgical features

The studies reported a range of histological findings relevant to ear conditions and surgical interventions. Chen et al.²⁰ observed rich collagen fibers and glandular structures in MAT grafts and dense collagen fibers in TF grafts, highlighting material-specific differences. Mantsopoulos et al.²⁷ identified dense keloid-like fibrosis in 73.3% of cases, along with lichenoid inflammation, Dense keloid-like fibrosis in 73.3% of cases, along with lichenoid inflammation, ectopic ceruminous glands, hyperkeratosis, and cholesteatoma in 46.6%. Diarra et al.³¹ described cholesteatoma with keratinizing squamous epithelium, while Sonvane et al.³³ reported residual or recurrent cholesteatoma and osteitis in cases with narrow meatoplasty. Additionally, observations included fibrous plugs in the EAC.³²

The surgical techniques employed varied significantly based on clinical needs and case complexity. Hovis et al.⁵ reported improved healing and cosmesis with a one-cut meatoplasty that avoided inferior cuts. Gumban and Almazan²² compared modified meatoplasty using a noon incision (a 12 o’clock endaural incision without removal of conchal cartilage and allowing healing by secondary intention) to Z Meatoplasty, where cartilage excision and Z-flap sutures were employed. Chen and Zang¹⁹ utilized endoaural incisions, local rotation flaps, and transposition split-thickness scalp flaps for complex reconstructions. Chen et al.²⁰ noted a transmeatal approach using areolar tissue grafts, avoiding external incisions entirely.

Several studies highlighted innovative techniques to prevent complications. Mantsopoulos et al.²⁷ performed bony canaloplasty with split-thickness skin grafts to widen the medial ear canal. Stultiens et al.³² reported the postauricular approaches and skin grafting to prevent restenosis. Suker et al.³⁰ described the CWD approach with cartilage removal and cavity packing using BIPP. Fu et al.²⁴ utilized Nagata auricular reconstruction method, while Carnevale et al.²⁵ achieved success with cartilage multi-layered palisade reconstruction and double-layered flap closure. Retroauricular pedicle flap,²⁹ temporal fascia and cartilage grafts,²³ and Bone dust for obliteration, cartilage grafts²⁸ were also noted as effective approaches. However, inadequate saucerization and high facial ridges were associated with residual disease in some cases (Table 2).³³

Comparative effectiveness of meatoplasty approaches

Comparative studies evaluated different meatoplasty techniques and found that modified meatoplasty and Z-meatoplasty generally provided similar outcomes in terms of surgical success. Hovis et al.⁵ documented varying cleaning schedules: 28.6% of patients had no cleaning, while others required cleaning every 6 months or yearly. Chen et al.²⁰ implemented weekly follow-ups for the first month, and Fu et al.²⁴ utilized a zero-pressure technique along with protective ear covers and high-pressure oxygen therapy. Regular dressing changes and close follow-up were emphasized in studies like Suker et al.³⁰ with Mantsopoulos et al.²⁷ opting for silicone strips and Gelfoam packing for graft stabilization. Gumban and Almazan²² conducted weekly evaluations to monitor for complications such as hyperemia, discharge, and canal narrowing. Additionally, Guo et al.²⁶ recommended tube maintenance for up to 3 months to prevent restenosis, underlying the importance of routine evaluations across studies.

The retrospective comparative study by Shady et al.³⁴ evaluated the outcomes of two different meatoplasty techniques—classic “Fisch” and “Corner-Tag”—performed after CWD tympanomastoidectomy in 48 patients with unsafe CSOM. Patients were evenly divided into two groups: Group A underwent the Fisch technique, and Group B the Corner-Tag technique. All surgeries were performed at Benha University Hospitals between 2021 and 2023. Both techniques had comparable rates of postoperative complications, including wound infection, granulation tissue, hypertrophic scarring, and canal stenosis. Only one patient (4.2%) in the Fisch group required revision surgery. The Corner-Tag technique resulted in a significantly wider meatal diameter after 1 year (10.50 ± 1.02 mm) compared to the Fisch group (9.63 ± 1.41 mm, p = 0.02), although it also required a longer time for epithelialization and healing (7.33 ± 0.96 weeks vs 6.5 ± 0.88 weeks, p = 0.003). Minor cosmetic deformities (cupped ear) were seen temporarily in 16.6% of Corner-Tag patients but resolved within 3 months. No long-term cosmetic issues were noted in either group. In conclusion, both techniques were effective and safe, but the Corner-Tag technique offered a better long-term canal diameter at the cost of slightly slower healing. The authors recommend further research with larger sample sizes and longer follow-up durations to validate these findings (Table 2).

Long-term maintenance

Long-term outcomes consistently showed stable results with minimal maintenance in most cases. Zafar and Kumar²¹ reported that a wide meatus was maintained, allowing for effective aeration, debridement, and drainage. Gumban and Almazan²² also found stable outcomes 4 weeks postoperatively. Carnevale et al.²⁵ ensured the stability of the mastoid cavity and cochlear implant positioning, while Nagaoka et al.²⁹ observed good canal patency with the use of antibiotic-soaked gauze packing. Stultiens et al.³² highlighted the importance of routine cleaning to ensure patient EACs and ventilation. Long-term dryness and ear health were maintained in studies by Abdulrahman²³ and Fu et al.²⁴ with the routine follow-up being emphasized in all cases (Table 2).

Patient-reported outcomes and quality of life

Patient-reported outcomes were largely positive, with many studies reporting significant improvements in QoL following surgery. Hovis et al.⁵ found that their technique facilitated hearing aid fitting. Chen et al.²⁰ reported an ABG improvement of 5.4 dB for MAT grafts and 3.4 dB for TF grafts. Mantsopoulos et al.²⁷ reported a significant short-term ABG improvement (15.5 ± 10.1 dB) and long-term improvement (19.4 ± 10.8 dB). Abdulrahman²³ and Fu et al. (2020) observed significant improvements in hearing thresholds, with Fu et al.²⁴ noting a 68.4% success rate. Diarra et al.³¹ found that hearing was improved in 91.17% of cases. Stultiens et al.³² noted a significant closure of the ABG within 20 dB in most cases. However, Suker et al.³⁰ reported a worsening of the ABG postoperatively in their cohort, indicating variability in outcomes (Table 2).

Comparative analysis between different meatoplasty techniques

Table 3 outlines the various meatoplasty techniques identified in the reviewed studies, categorizing them by their key procedural characteristics and primary references. Each approach—such as one-cut, Z-meatoplasty, modified techniques, and more advanced reconstructive methods like retroauricular flaps or bony canaloplasty—is defined by its incision design, tissue manipulation, and reconstructive goals. The diversity of approaches demonstrates the adaptability of meatoplasty based on underlying pathology (e.g., cholesteatoma, congenital stenosis) and the desired postoperative anatomy. These variations reflect both the evolution of surgical innovation and the importance of tailoring the technique to each patient’s anatomical and clinical needs.

Table 3.

Comparison between different techniques.

Technique	Description	Key studies
One-cut meatoplasty	A single incision avoids inferior cuts to enhance healing and cosmetic outcomes	Hovis et al.⁵
Z-meatoplasty	A Z-shaped incision involving conchal cartilage excision and flap suturing	Gumban and Almazan²²
Modified meatoplasty	Varies; include incisions at 12 o’clock without cartilage removal or additional reconstructive steps	Gumban and Almazan,²² Chen and Zhang¹⁹
Fisch and corner-tag techniques	Postauricular approaches with different flap designs post-CWD mastoidectomy	Shady et al.³⁴
Retroauricular pedicle flap	A skin flap tunneled under the conchal bowl, sewn into the EAC	Nagaoka et al.²⁹
Wide meatoplasty with skin grafts	Ensures ventilation and prevents restenosis	Stultiens et al.³²
Meatal areolar tissue (MAT) graft	Minimally invasive transmeatal approach using areolar tissue	Chen et al.²⁰
Bony canaloplasty + Split-thickness skin grafts	Medial EAC widening plus skin grafts to reduce restenosis	Mantsopoulos et al.²⁷

Table 4 compares the main outcomes and characteristics of the different meatoplasty techniques, including healing time, cosmesis, complications, and long-term effectiveness. The one-cut and modified techniques showed excellent healing and cosmetic results, while more complex approaches like the Corner-Tag or Z-meatoplasty offered improved canal patency at the cost of slower healing or transient cosmetic effects. Restenosis was more commonly associated with procedures requiring extensive canal manipulation, such as bony canaloplasty. Importantly, patient satisfaction was generally high across all techniques, highlighting that with appropriate technique selection and follow-up care, favorable outcomes are achievable regardless of the surgical variation used.

Table 4.

Comparison between the outcomes of different meatoplasty techniques.

Feature	One-cut	Z-meatoplasty	Modified	Fisch	Corner-tag	Others (MAT, bony, retroauricular)
Cosmesis	Excellent	Moderate	Good	Good	Temporary deformity (resolved)	Variable
Healing time	Moderate	Slightly delayed	Quick	Faster than corner-tag	Slightly slower	Longer (skin grafts, flaps)
Meatal size	Adequate	Adequate	Variable	Narrower than corner-tag	Widest meatus (p = 0.02)	Large/measured/preserved
Complications	3.6% stenosis	Higher hyperemia, less narrowing	Granulations, stenosis rare	Low complication	Some granulation, but no severe issues	Restenosis (Mantsopoulos), flap necrosis²⁴
Revision rates	Low	Low	Low	One revision	None reported	Moderate (up to 29.3%)
Postoperative care	Periodic cleaning	Frequent monitoring	Cotton/gauze packing	Quarterly follow-up	Close epithelialization tracking	Extensive (silicone strips, dressing)
Patient satisfaction/QoL	High (good aid fit)	Good	Good	High	High	High, particularly in aesthetics²⁴

Qualitative descriptors (e.g., good, moderate, excellent) were assigned based on the terminology and outcome summaries used by the original study authors. Where numerical outcomes were provided (e.g., percentage of dry ears or ABG closure), interpretation was based on general clinical benchmarks. However, no standardized scoring tool was applied across studies, and heterogeneity in reporting is acknowledged.p values of <0.05 were considered statistically significant in bold.

Regarding functional outcomes, across the reviewed studies, functional outcomes following various meatoplasty techniques were largely positive, particularly in terms of hearing improvement and the achievement of a dry ear. All surgical approaches demonstrated improvements in the ABG, indicating enhanced auditory function postoperatively. Notably, the use of MAT grafts, as explored by Chen et al.²⁰ resulted in a mean ABG improvement of 5.4 dB, reflecting both graft integrity and functional efficacy. A comparative analysis of the Fisch and Corner-Tag techniques by Shady et al.³⁴ showed comparable hearing restoration between the two; however, the Corner-Tag approach yielded a wider postoperative meatal diameter, which may facilitate better canal aeration and hygiene. Stultiens et al.³² further corroborated the success of meatoplasty in hearing outcomes, with 83% of patients achieving an ABG closure within 20 dB in the short term—demonstrating significant auditory gain in a majority of cases. Dry ear status—another vital outcome in chronic ear surgery—was consistently achieved across the techniques, with multiple studies reporting high rates of postoperative dryness. Diarra et al.³¹ found that otorrhea was absent in 88.23% of cases post-surgery, underscoring the procedure’s effectiveness in controlling chronic ear discharge. Similarly, Zafar and Kumar²¹ observed sustained dry meatuses in patients over a full year of follow-up, reinforcing the long-term stability of meatoplasty outcomes. These results reflect the success of the procedure not only in anatomical correction but also in restoring critical physiological functions of the EAC.

Regarding the histological outcomes, the choice of graft material and surgical reconstruction technique plays a pivotal role in the success of meatoplasty, with distinct histological and structural features influencing outcomes. In comparative analyses of graft materials, MAT grafts were found to contain abundant glandular structures and rich collagen fibers, which are favorable for rapid and robust epithelialization of the ear canal.²⁰ In contrast, temporalis fascia (TF) grafts were characterized by dense collagen fibers but lacked glandular components, possibly affecting integration and surface moisture regulation. These tissue-specific histological differences suggest that MAT may offer a slight advantage in healing dynamics, especially in minimally invasive approaches. Advanced reconstructive strategies were applied in more complex cases, particularly those involving congenital anomalies or significant canal deficits. Fu et al.²⁴ utilized the Nagata auricular reconstruction method for patients with congenital aural stenosis, achieving both aesthetic and functional restoration of the external ear canal. Carnevale et al.²⁵ reported the use of a cartilage palisade technique combined with double-layered flap closure in patients undergoing cochlear implantation post-meatoplasty, ensuring long-term stability of both the neocanal and implant sites. These sophisticated reconstructive techniques highlight the adaptability of meatoplasty in managing a broad spectrum of anatomical and pathological presentations while reinforcing the importance of individualized surgical planning.

Table 5 summarizes the major advantages and limitations of each meatoplasty technique, assisting in clinical decision-making. Simpler techniques like the one-cut or modified approaches offer ease of performance and good cosmetic outcomes, but may fall short in severe stenosis cases. In contrast, techniques like the Corner-Tag and Z-meatoplasty provide superior canal enlargement but require greater surgical precision and longer healing periods. Understanding these trade-offs is vital for surgeons when selecting the most appropriate method based on individual patient factors, surgical goals, and expected complications.

Table 5.

Comparison between different techniques in advantages and limitations.

Technique	Advantages	Limitations
One-cut	Fast, minimal tissue trauma, good aesthetics	Limited enlargement in severe stenosis
Z-plasty	Better canal patency in narrowed cases	Hyperemia, complex flap closure
Modified	Simple, adaptable	Variable meatal size, some restenosis
Corner-tag	Widest meatal diameter, low revision	Slower healing, temporary cosmetic issues
Fisch	Fast healing, low granulation	Narrower meatus
MAT grafts	No external incisions, high success	Short follow-up (4.6 months), graft variability
Bony canaloplasty	Suitable for fibrosis, provides a wide lumen	Technically demanding, higher revision rate
Retroauricular flap	Preserves vascularity	Risk of keloid, complex dissection

Quality assessment

The NOS evaluates study quality across Selection, Comparability, and Exposure/Outcome domains. High-quality studies (7 stars: Zafar and Kumar,²¹ Fu et al.,²⁴ Nagaoka et al.,²⁹ 8 stars: Shady et al.,³⁴) demonstrate robust methods and reliable results. Moderate-quality studies (5–6 stars) show sound methodology but with some limitations, requiring cautious interpretation. Low-quality studies (3–4 stars) lack rigor and are less reliable. Overall, high-quality studies should guide conclusions, with moderate-quality studies providing context and low-quality studies treated as exploratory (Table 6).

Table 6.

NOS for non-randomized studies.

Studies	Selection	Comparability	Exposure/outcome	Overall star rating
Hovis et al.⁵	**	*	***	6
Chen and Zhang¹⁹	*		**	3
Chen et al.²⁰	*	*	***	5
Zafar and Kumar²¹	***	*	***	7
Abdulrahman²³	***	*	**	6
Fu et al.²⁴	***	*	***	7
Carnevale et al.²⁵	**	*	**	5
Guo et al.²⁶	**	*	**	5
Mantsopoulos et al.²⁷	**	*	**	5
Kara et al.²⁸	***	*	**	5
Nagaoka et al.²⁹	***	*	***	7
Suker et al.³⁰	**	*	**	5
Diarra et al.³¹	**	*	**	5
Stultiens et al.³²	**	*	*	4
Sonvane et al.³³	**	*	*	4
Shady et al.³⁴	***	**	***	8

asterisks (*) indicate the number of scores awarded for meeting specific quality criteria (maximum 9 stars: Selection up to 4, Comparability up to 2, Outcome/Exposure up to 3).

The Cochrane Risk of Bias assessment for Gumban and Almazan²² shows a low risk in key domains such as random sequence generation, allocation concealment, blinding of participants, and handling of incomplete data. However, unclear risks in outcome assessor blinding, selective reporting, and other potential biases highlight the need for cautious interpretation despite the study’s generally strong methodology (Table 7).

Table 7.

The Cochrane risk of bias assessment for RCTs.

Study	Random generation sequence	Allocation concealment	Blinding of participants and personnel	Blinding of outcome assessment	Incomplete outcome data	Selective reporting	Other bias
Gumban and Almazan²²	Low	Low	Low	Unclear	Low	Unclear	Unclear

Discussion

The review underscores significant advancements in meatoplasty techniques and related surgical approaches for treating chronic ear conditions. Procedures such as modified meatoplasty, Z-meatoplasty, CWD mastoidectomy, bony canaloplasty, and innovative reconstruction methods like cartilage multi-layered palisade techniques and Nagata auricular reconstruction have shown remarkable efficacy. These interventions address key symptoms, including chronic ear discharge, hearing loss, otalgia, cholesteatoma, and tympanic membrane perforation, while achieving notable postoperative outcomes such as improved hearing thresholds, dry ear status, and enhanced quality of life.

High graft success rates, stable long-term outcomes, and minimal complications were consistent across studies, with approaches such as transmeatal techniques, split-thickness skin grafting, and retroauricular pedicle flaps contributing to surgical success. Although complications like meatal stenosis, granulation tissue formation, and restenosis were occasionally observed, they were typically manageable through diligent postoperative care and innovative surgical strategies.

The findings highlight the critical role of tailored surgical methods, meticulous follow-up, and routine maintenance in ensuring enduring patient benefits. These advancements in meatoplasty and its associated approaches confirm their effectiveness in not only restoring ear function but also significantly enhancing the overall quality of life for patients with chronic ear conditions. These results align with previously published reports that represented the advantages of meatoplasty in restoring the patency of the ear canal and resolving chronic ear symptoms such as discharge, hearing loss, and pain.^13,21,32 It is important to interpret the outcomes of meatoplasty in light of the underlying pathology. For example, in CSOM or cholesteatoma, meatoplasty facilitates drainage, and infection control, whereas in congenital stenosis, it aims to establish or maintain canal patency. Therefore, comparisons across indications are not absolute but provide an overview of technique adaptability and safety.

The demographic characteristics of the patient populations in the included studies had a wide range of variability ranging from pediatric patients with congenital ear conditions to adults and elderly individuals. Consequently, the gender distribution had a predominance of male patients in most of the studies but with a proportion of males that varied between 45% and 70%. These results represented the wide versatility of meatoplasty among different patients and emphasized the need to tailor treatment approaches according to factors such as age, gender, and the condition in question. Moreover, conditions such as COM, cholesteatoma, and EAC stenosis were common across the studies, reinforcing the broad range of conditions for which meatoplasty is considered an effective intervention.

One of the most significant observations is the wide variation of surgical techniques used in the different studies. Some studies applied one-cut meatoplasty, while others applied Z-plasty or modified approaches with graft materials, such as TF, cartilage, or free skin flaps. The variability in the surgical techniques reflects the flexibility of the procedure based on the pathology being treated. For instance, in cases involving severe canal stenosis or cholesteatoma, more extensive procedures such as tympanoplasty or mastoidectomy were often required alongside meatoplasty. Regarding outcomes, both techniques of one-cut and Z-plasty meatoplasty proved to be effective, but some minor differences in postoperative complications, such as hyperemia or canal narrowing, can influence the choice of technique in clinical practice.

The postoperative outcomes were largely positive, with most of the patients having improvements in dryness of the ear, hearing, and the resolution of chronic ear discharge. These are aligned with the primary goals of meatoplasty that involve restoring normal anatomy and function of the ear canal. Research, such as that conducted by Zafar and Kumar,²¹ observed a high rate of dry ear achievement after surgery; hence, meatoplasty can be an effective remedy to deal with one of the most distressing symptoms of chronic ear conditions. Follow-up over a long period showed that most patients maintained their results and showed no recurrence of infections or cholesteatoma. However, some patients required revision surgeries due to restenosis or cosmetic issues, indicating that while the procedure is generally successful, ongoing care is essential for optimal results.

Moreover, the complications following the meatoplasty were significantly rare. Meatal stenosis, formation of granulation tissue, and keloid development are the most common postoperative complications. These complications can easily be managed with follow-up interventions like chemical cautery or, in some cases, revision surgeries. The incidence of severe complications such as loss of hearing or infections was low, which is quite encouraging and supports the safety profile of the procedure. However, long-term follow-up and maintenance care cannot be overemphasized, as several of the studies have stressed routine follow-up to avoid complications like restenosis or recurrent infections. Most studies suggested a follow-up between 3 and 12 months with continued cleaning and monitoring for signs of stenosis or infection. Patients with complicated conditions such as EAC atresia or cholesteatoma would especially benefit from these follow-ups because their condition carries a higher risk of developing complications.

However, meatoplasty can be considered an effective surgical intervention for treating a wide range of ear conditions, with favorable outcomes in terms of symptom resolution and QoL improvement. Moreover, the choice of surgical technique should be tailored to the individual patient’s condition, and long-term follow-up is critical to ensure lasting success. Although postoperative complications may arise, there is enough evidence to consider the safety and efficacy of meatoplasty, which necessitates further research on techniques and improved patient outcomes.

Limitations and future directions

While this systematic review contributes valuable insight into meatoplasty and its role in chronic ear surgeries, several important limitations must be acknowledged. First, there was significant heterogeneity among the included studies in terms of design, patient populations, surgical techniques, and outcome measures. This variability limits the comparability of results and precludes firm conclusions about the relative efficacy of individual meatoplasty approaches. Second, the presentation of data across studies was often dense and unstructured, making it difficult to extract consistent, quantifiable endpoints—particularly when outcomes were reported qualitatively or without standardized criteria. Third, the absence of a meta-analysis or pooled statistical synthesis of outcomes limits the strength of the review’s conclusions. While the diversity of study designs made formal meta-analysis unfeasible, its absence reduces the analytical depth and overall impact of the review. Moreover, some studies contain small sample sizes (less than 7 patients). A key limitation of this review is the difficulty in isolating the direct effects of meatoplasty from the outcomes of the broader surgical procedures in which it was performed. In nearly all included studies, meatoplasty was conducted alongside interventions such as tympanoplasty, mastoidectomy, or canaloplasty, which themselves contribute significantly to clinical improvements like dry ear status, resolution of infection, and hearing restoration. As a result, outcomes such as the absence of otorrhea, graft success, or improved ABG cannot be definitively attributed to meatoplasty alone. This limitation restricts the ability to assess the standalone efficacy of meatoplasty and underscores the need for future studies with more controlled comparisons or study designs that evaluate meatoplasty in isolation or with minimal procedures. Future research should focus on standardized protocols for meatoplasty approaches and long-term follow-up studies to assess the durability of outcomes. Additionally, comparative studies between specific surgical techniques of meatoplasty are needed to establish best practices in chronic ear surgery.

Conclusion

The advancements in meatoplasty and related techniques have proven highly effective in treating chronic ear conditions and improving symptoms, hearing, and quality of life. High graft success rates and minimal complications highlight their efficacy, while innovative strategies and diligent postoperative care address occasional issues like stenosis, ensuring excellent long-term outcomes. In conclusion, the comparative analysis of meatoplasty techniques reveals that while all approaches are effective in restoring auditory function and achieving a dry ear, their specific advantages and limitations vary based on surgical complexity, patient pathology, and anatomical considerations. Simpler techniques like the one-cut and modified meatoplasty offer excellent cosmetic outcomes and ease of execution, making them suitable for routine cases. In contrast, more advanced methods such as Z-meatoplasty, Corner-Tag, and bony canaloplasty provide superior canal patency and are particularly advantageous in managing stenosis, fibrosis, or complex reconstructions. Graft selection, notably the use of MAT or TF, plays a crucial role in epithelialization and healing, while advanced reconstructions like cartilage palisade techniques are invaluable in anatomically challenging cases. Overall, the evidence underscores that no single technique is universally superior; rather, the optimal choice should be guided by the individual patient’s condition, the surgeon’s expertise, and long-term maintenance goals to ensure durable, functional, and aesthetically favorable outcomes.

Supplemental Material

sj-docx-1-smo-10.1177_20503121251376179 – Supplemental material for Effectiveness of meatoplasty techniques alone or as adjunct to other surgeries in chronic ear disease: A systematic review

Supplemental material, sj-docx-1-smo-10.1177_20503121251376179 for Effectiveness of meatoplasty techniques alone or as adjunct to other surgeries in chronic ear disease: A systematic review by Mariam Aljehani, Ibrahim Tawfiq, Fida Al-Muhawas and Abdulrhman Alsanosi in SAGE Open Medicine

Footnotes

Acknowledgements

Not applicable.

ORCID iD

Mariam Aljehani

Ethical considerations

Not applicable.

Author contributions

Mariam Aljehani: Conceptualization, Methodology, Data curation, Investigation, Validation, Visualization, Writing – original draft, Writing – review & editing, Supervision, and Project administration. Ibrahim Tawfiq: Conceptualization, Investigation, Validation, Visualization, Writing – original draft, and Writing – review & editing. Fida Al-Muhawas: Investigation, Data curation, Validation, Writing – original draft, and Writing – review & editing. Abdulrhman Alsanosi: Methodology, Data curation, Writing – original draft, and Writing – review & editing. All authors approved the final manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental material

Supplemental material for this article is available online.

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