Transcanal Approach with Osteotomy Versus Retroauricular Approach with Microdrill for Canaplasty in Exostosis and Osteomas
We are happy to have our article reviewed by Dr. Hetzler, who is an authority on the subject. We agree with Dr. Hetzler that in experienced hands, the osteotomy technique is well suited in exostosis and osteoma treatment. It is true that using an osteotome through a transcanal approach as practised by Hetzler et al. (1,2) has obvious advantages such as being minimally invasive, faster healing time, and the prevention of some degree of high-frequency hearing loss that is inevitable with the use of the microdrill. However, using the osteotome can be dangerous in inexperienced hands and injury to the tympanic membrane, ossicular chain, and the facial nerve has been reported in the literature. The drill is a familiar tool that is routinely used by every otologist and hence can be employed safely even by inexperienced surgeons. Also, the degree of high-frequency hearing loss due to drilling is minimal and must not be over-emphasized. The retroauricular approach offers adequate space to maneuver the drill, thereby increasing the comfort levels of the operating surgeon and lowering the complications.