Questioning the value of stalk drilling after external auditory canal osteoma excision: case series, literature review, and meta-analysis

Objectives: To question the value of drilling the site of the stalk (“insertion site” or “stalk” drilling) of a pedunculated external auditory canal osteoma (EACO) in reducing recurrence. Data sources: A retrospective medical chart review of all patients treated for EACO in one tertiary medical center, a systematic literature review using Medline via “PubMed”, “Embase”, and “Google scholar” search, and a meta-analysis of the proportion for recurrence of EACO with and without drilling. Results: The local cohort included 19 patients and the EACO origin was the anterior EAC wall in 42% and the superior EAC wall in 26%. The most common presenting symptoms were aural fullness and impacted cerumen (53% each), followed by conductive hearing loss (42%). All patients underwent post-excision canaloplasty, and one sustained EACO recurrence. Six studies suitable for analysis were identified (63 EACOs). Hearing loss, aural fullness, otalgia, and cerumen impaction were the most common clinical presentations. The most common EACO insertion site was the anterior EAC wall (37.5%), followed by the superior EAC and posterior walls (25% each). The inferior EAC wall was least affected (12.5%). There was no significant difference in recurrence between EACOs whose stalk insertions were drilled (proportion 0.09, 95% confidence interval [CI] 0.01–0.22) to the ones whose insertion was not drilled (proportion 0.05, 95% CI 0.00–0.17). The overall recurrence proportion was 0.07 (95% confidence interval 0.02–0.15). Conclusion: EACO insertion site drilling does not reduce recurrence and should be avoided in the absence of a definite pedicle projecting to the EAC lumen.