We reviewed the results of surgical treatment of 14 ears with middle ear cholesterol granulomas. The goals of surgery for cholesterol granulomas are to remove the focus and improve the ventilation disorder. There are two ways to treat the mastoid cavity in surgery for cholesterol granulomas: one is to form a pneumatic cavity by keeping the ventilation route (canal wall up (CWU), canal wall down (CWD) and canal reconstruction), and the other is to lighten the burden of the Eustachian tube by narrowing the ventilation space (CWU with mastoid obliteration, CWD).
The results of 3 ears treated by CWU, 5 ears treated by CWD with canal reconstruction, 2 ears treated by CWU with mastoid obliteration, and 4 ears treated by CWD are presented. The success rate for good control of otorrhea was 87.5% in cases in which the surgery involved formation of the pneumatic cavity, and 100% in cases in which the surgery involved reducing the burden of the Eustachian tube by narrowing the ventilation space. The success rate for hearing improvement was 37.5% in cases in which the surgery involved formation of the pneumatic cavity, and 50.0% in cases in which the surgery involved reducing the burden of the Eustachian tube. The hearing improvement following treatment for cholesterol granuloma seemed to be related not only to ventilation, but also to the presence/absence of other disorders, such as fixation of the ossicles or lack of fit of the columella. The degree of inflammation of the mastoid and tympanic cavities is also a very important factor for selecting the type of surgery.
In conclusion, if inflammation of the mastoid cavity is not very severe, surgery to form the pneumatic mastoid cavity would be recommended, whereas surgery to reduce the ventilation space, such as obliteration of the mastoid cavity or CWD, would be performed in cases with severe inflammation, with granulation tissue filling the mastoid cavity.
