Acquired medial canal fibrosis is a discrete clinicopathological entit
y characterized by formation of fibrous tissue in the bony external au
ditory meatus. Over a seven-year period, a total of 14 operative proce
dures were performed on 12 ears involving 10 patients. Four cases had
followed otitis externa, two were complications of suppurative otitis
media, and three cases were iatrogenic. The cause could not be identif
ied in three ears involving two patients. Treatment entails excision o
f all the fibrous tissue and involved skin, a wide canaloplasty, a mea
toplasty, and then reconstruction by split skin graft. Two cases of ca
nal cholesteatoma were encountered. Average follow-up of two years sho
wed hearing improvement in all patients. The only complication was a r
ecurrence of the stenosis in two ears. The paper discusses terminology
, aetiology, pathophysiology, diagnosis, and principles of treatment o
f this condition.