Bulky Foreign Body in a Canal Wall-Down Mastoid Cavity Removed Exclusively via a Transcanal Approach

Abstract

Foreign body intrusion caused by silicone impression material is a recognized complication of hearing aid mold procedures. However, its occurrence within a canal wall-down mastoidectomy (CWDM) cavity lacking tympanic membrane structures is rare, and successful transcanal removal under endoscopic guidance is even more exceptional. Herein, we describe the case of a 63-year-old woman in whom a CWDM cavity was accidentally filled with silicone impression material during hearing aid fitting. Computed tomography revealed dense material occupying 44.31% of the cavity volume. As the patient could not discontinue dual antiplatelet therapy and preferred to avoid a postauricular incision for cosmetic reasons, transcanal removal under local anesthesia was attempted. Using an endoscope, the material was fragmented and extracted in several pieces without the need for a new incision. Although the single-handed nature of endoscopic surgery can limit manipulation, in this patient, the wide field of view of the middle-ear mucosa provided by the endoscope compensated for the lack of bimanual traction typically available under microscopy. The procedure was completed uneventfully, and follow-up at 4 years revealed a dry, well-epithelialized cavity with no recurrence. This case demonstrates that endoscopic transcanal removal is a viable approach for managing bulky foreign bodies in a CWDM cavity under local anesthesia without additional incisions.