# Hearing Preservation and Complications of the Middle Cranial Fossa Approach for Otolaryngological Diseases: Twelve-Year Single-Center Experience

## TL;DR

This study examines the safety and effectiveness of a specific surgical approach for ear diseases, focusing on hearing preservation and complications.

## Contribution

The study provides a twelve-year single-center analysis of the middle cranial fossa approach's outcomes in otolaryngological surgeries.

## Key findings

- MCF procedures accounted for 1.4% of all otologic surgeries at the center.
- Hearing was preserved in patients without internal auditory canal manipulation.
- Intracranial complications occurred in 11.4% of cases, including seizures and cerebral infarction.

## Abstract

Objectives: The middle cranial fossa (MCF) approach is valued for preserving hearing while accessing the internal auditory canal (IAC), petrous apex, inner ear, and related structures. This study evaluated its clinical outcomes across otolaryngological diseases, focusing on postoperative complications, hearing preservation, and the effect of IAC manipulation on auditory function. Methods: We retrospectively analyzed 35 patients who underwent MCF otologic surgery at a single center over twelve years. We calculated the proportion of MCF cases among all otologic surgeries and assessed postoperative complications and hearing changes (bone conduction thresholds). Outcomes were compared between patients with and without IAC manipulation. Results: MCF procedures comprised 1.4% of all otologic surgeries. Petrous bone cholesteatoma was the leading indication (15 cases). Intracranial complications occurred in 4 patients (11.4%): seizures, epidural abscess, and cerebral infarction. Facial nerve paralysis occurred in 3 (10.7%) patients without any cerebrospinal fluid leaks. In patients without IAC manipulation, hearing functions were preserved (22.3 ± 7.8 dB HL pre- vs. 25.7 ± 9.5 dB HL postoperatively), whereas those with IAC manipulation showed significantly greater deterioration. Conclusions: The middle cranial fossa approach, though technically demanding and infrequently used, offers a safe and effective option across various otolaryngological diseases. This approach achieved favorable hearing preservation with a low complication rate, particularly when intradural manipulation of the IAC was not required.