Stenosis and atresias of the external auditory canal (EAC) are rare conditions difficult to manage with success. The main reason to operate is severity of the hearing impairment and threatening cholesteatoma of the EAC. Some authors do not find classical surgical methods sufficient and they favor the use of KTP/532 laser, or larger surgical procedures. The proven ability of Mitomycin C (MMC) to inhibit fibroblasts in vitro has stimulated its use it in treatment to prevent stenosis and adhesion, also in otorhinolaryngology. The objective of the study was to evaluate the opening of the external auditory canal in fibrotic atresias (congenitally and secondary) and the hearing improvement, after the surgery and concomitant use of topical MMC. Methods: Ten patients, all together fourteen ears, with fibrotic external auditory canal (EAC) atresias due to chronic external otitis, post-traumatic, post irradiated, or congenital cause were included. During the surgical procedure ? meatoplasty only endaural approach was used, and 1 mL of MMC (0.4 mg/mL) was applied for 4 minutes to the EAC. In 5 ears the application of MMC was repeated one to six month later, than 1mg/mL concentration of MMC was used. During the application of MMC the tympanic membrane was protected with a thin layer of dry Gelfoam. Audiometric evaluation included pre and postoperative air-conduction thresholds (AC) and bone-conduction thresholds (BC). Results: Between 9 and 56 months after the surgery and concomitant application of MMC the microscope visual control of opening of EAC was assessed. The hearing improvement was observed by using preoperative and postoperative pure tone threshold audiograms (PTA). In 10 ears (72 %) the ear canals reminded open with a postoperative air-bone gap of 10 dB or less. No sensorineural hearing loss was detected after surgery. Conclusions: 1) MMC used on a limited number of ears during surgery was effective in preventing scaring in fibrosis ending with atresias of EAC. 2) No complications or sensorineural hearing loss were encountered after surgery and MMC application. 3) The results of our study are comparable with the published reports and according to the follow up period our outcome results with a success rate of 72% could be considered as final.

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