Management of the external auditory canal in skull base surgery.

Transtemporal approaches to the skull base are being used with increasing frequency. When the external auditory canal is transected in the course of these operations, the risk of cerebrospinal fluid fistula is created. When hearing is to be sacrificed, we use a modification of the technique developed by Rambo for closure of the external auditory canal. This technique permits a cosmetically acceptable reliable watertight closure. When hearing is to be salvaged, we use a "conchal flap technique," which prevents circumferential scarring and stenosis and permits a watertight suture closure.