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Article

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

by
Toshihito Sahara
1,
Takeshi Fujita
2,*,
Yujiro Hoshi
3,
Hajime Koyama
1,
Anjin Mori
1,
Yasuhiro Osaki
4,
Akinori Kashio
1,
Yasuhiro Sanada
5 and
Katsumi Doi
6,*
1
Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
2
Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
3
Department of Otorhinolaryngology, Mitsui Memorial Hospital, Tokyo 101-8643, Japan
4
Department of Otorhinolaryngology, Ikeda City Hospital, Ikeda 563-8510, Japan
5
Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
6
Ear Center, Iseikai International General Hospital, Osaka 530-0052, Japan
*
Authors to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(21), 7874; https://doi.org/10.3390/jcm14217874
Submission received: 17 September 2025 / Revised: 23 October 2025 / Accepted: 31 October 2025 / Published: 6 November 2025
(This article belongs to the Section Otolaryngology)
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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.
Keywords: middle cranial fossa approach; vestibular schwannoma; petrous bone cholesteatoma; MCF middle cranial fossa approach; vestibular schwannoma; petrous bone cholesteatoma; MCF

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MDPI and ACS Style

Sahara, T.; Fujita, T.; Hoshi, Y.; Koyama, H.; Mori, A.; Osaki, Y.; Kashio, A.; Sanada, Y.; Doi, K. Hearing Preservation and Complications of the Middle Cranial Fossa Approach for Otolaryngological Diseases: Twelve-Year Single-Center Experience. J. Clin. Med. 2025, 14, 7874. https://doi.org/10.3390/jcm14217874

AMA Style

Sahara T, Fujita T, Hoshi Y, Koyama H, Mori A, Osaki Y, Kashio A, Sanada Y, Doi K. Hearing Preservation and Complications of the Middle Cranial Fossa Approach for Otolaryngological Diseases: Twelve-Year Single-Center Experience. Journal of Clinical Medicine. 2025; 14(21):7874. https://doi.org/10.3390/jcm14217874

Chicago/Turabian Style

Sahara, Toshihito, Takeshi Fujita, Yujiro Hoshi, Hajime Koyama, Anjin Mori, Yasuhiro Osaki, Akinori Kashio, Yasuhiro Sanada, and Katsumi Doi. 2025. "Hearing Preservation and Complications of the Middle Cranial Fossa Approach for Otolaryngological Diseases: Twelve-Year Single-Center Experience" Journal of Clinical Medicine 14, no. 21: 7874. https://doi.org/10.3390/jcm14217874

APA Style

Sahara, T., Fujita, T., Hoshi, Y., Koyama, H., Mori, A., Osaki, Y., Kashio, A., Sanada, Y., & Doi, K. (2025). Hearing Preservation and Complications of the Middle Cranial Fossa Approach for Otolaryngological Diseases: Twelve-Year Single-Center Experience. Journal of Clinical Medicine, 14(21), 7874. https://doi.org/10.3390/jcm14217874

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