A Study on 65 Cases of Congenital Aural Fistula Treated by Surgery

We conducted a clinical study of 65 patients (83 fistulas) with congenital aural fistula who had undergone surgical treatment at our hospital during the 12-year period from January 2012 to December 2023. The 65 patients included 23 male and 42 female patients aged between 2 and 89 years (mean age, 24.7 years; median age 17 years); the majority were teenagers. The site of occurrence of the fistula was the pre-helix in 65 fistulas (78.3%), the crus helix in 15 fistulas (18.1%), and the crus antihelix in 3 fistulas (3.6%). Bacteriological examinations were carried out for 25 fistulas. The results revealed only aerobic bacteria in 7 fistulas (28.0%), only anaerobic bacteria in 3 fistulas (12.0%), aerobic plus anaerobic bacteria in 4 fistulas (16.0%), commensal bacteria in 1 fistula (4.0%), and harmful bacteria in 10 fistulas (40.0%). The operation was performed in the presence of inflammation in 34 fistulas (50.0%), within one month of resolution of inflammation in 9 fistulas (13.2%), more than one month after resolution of inflammation in 12 fistulas (17.6%), and the time of resolution of inflammation was unknown in 13 fistulas (19.1%). The duration of operation and postoperative hospitalization period did not differ significantly between single and multiple infected fistulas, or between fistulas operated upon in the presence of inflammation and those operated upon after resolution of the inflammation. Among the 68 fistulas operated upon in the presence of inflammation or after resolution of the inflammation, recurrence occurred in 3 fistulas (4.4%). Based on the results of this study, we concluded that aggressive wide excision surgery, including removal of the scar tissue and abscesses, should be actively performed in cases where the conservative treatment period may be prolonged or skin damage may remain even during infection, regardless of the number of infectious episodes, in order to quickly relieve the patient distress.