2017 Volume 151 Pages 20-21
Langerhans cell histiocytosis is a disease of unknown cause, characterized by abnormal proliferation of Langerhans cells. It may manifest as functional disorders of the liver and spleen, and/or as osteolytic lesions. The temporal bone is occasionally affected by Langerhans cell histiocytosis. Lateralized tympanic membrane usually occurs after operations on the external auditory canal or middle ear, or in association with injury and inflammation of the external ear. It may sometimes cause medial meatal fibrosis (MMF). A case of transcanal endoscopic ear surgery for lateralized tympanic membrane that arose as a complication after treatment of Langerhans cell histiocytosis is reported.
A patient was a 6-year-old boy who was brought to our hospital 4 years ago with intractable otorrhea on both sides. Biopsy of the tumor detected in the external auditory canal revealed the diagnosis of Langerhans cell histiocytosis. Ahead CT revealed several mass lesions with bone destruction of the skull and soft-tissue shadows in the external auditory canals of both sides. The patient received chemotherapy at the Department of Pediatrics and enterd remission after four years of treatment. Subsequently, he suffered from binaural conductive hearing loss caused by a lateralized tympanic membrane. A repeat CT showed soft-tissue shadows within both external auditory canals. We made the diagnosis of MMF developing after treatment for Langerhans cell histiocytosis. Transcanal endoscopic ear surgery was performed for the MMF on both sides, step-by step. An endoscope offers several advantages over a microscope: a wide field of view, higher magnification on close approach of the object, and clear visualization of structures that are hidden when a microscope is used. Thus, transcanal endoscopic ear surgery appears to be very useful for the treatment of the lateralized tympanic membrane, specifically for management around the tympanic annulus.
