Analysis of the Surgical Treatment for Middle Ear Cholesterol Granuloma

Abstract

Middle ear cholesterol granuloma is still an intractable ear disease, and its pathogenesis has not been clearly demonstrated. In this study, we evaluated treatment of middle ear cholesterol granuloma.
We reviewed middle ear cholesterol granuloma in 16 ears that underwent surgical treatment at Kurume University Hospital between 1990 and 2006.
Cases that were healed by ventilation tube insertion only and those combined with other middle ear disease such as cholesteatoma were excluded from this study. We analyzed the relation between preoperative findings of the tympanic membrane and postoperative course. Preoperative findings of the tympanic membrane were grouped into the swollen type or retracted type. The cases that underwent myringotomy more than twice, showed persistent otorrhea from the tympanic ventilation tube, or the ventilation tube was missed were classified as showing a poor postoperative course. Cases without the above symptoms were classified as showing a good postoperative course. The hearing results were analyzed using the Guidelines for Evaluating Hearing Results after Middle Ear and Mastoid Surgery published by the Otological Society of Japan (2000).
The postoperative courses of patients with a swollen tympanic membrane were significantly poorer. The postoperative courses of those with a retracted tympanic membrane and those undergergoing ossicular chain reconstruction showed significantly better results. However, 3 of 4 cases showing swollen tympanic membrane achieved a good passage. Such cases underwent posterior tympanotomy with ossicular chain reconstruction.
Success rate for hearing improvement at about 14 post operative days was 75%. Yet, beyond 6 months postoperatively, the success rate deteriorated to 62.5%. Cases showing a poor hearing result at 14 postoperative days never showed a permanently improved hearing result.
To acquire better postoperative results in patients with swollen tympanic membrane, posterior tympanotomy with ossicular chain reconstruction is highly recommended.