Abstract
When recognizing severe retraction or adhesion of debris to the tympanic membranes, the otologist tends to regard these as cholesteatoma or adhesive otitis media, and usually performs ear surgery. Some of these could obtain a stable local condition by conservative therapy as an office procedure. This paper reports five cases, in which ear surgery was avoided by conservative therapy.
Case 1: A 9-year-old girl consulted our clinic with a long history of otitis media with effusion. A deep atticdefect of the left tympanic membrane with relapsing otorrhea and debris was recognized. A stable condition in the tympanic membrane was acquired by conservative local treatment; irrigation, cleaning, antibiotic ear drip, and ventilation tube insertion. Case 2: A 12-year-old girl was referred for further examination of suspected external canal cholesteatoma. Infected granulation and debris of the posterior bony wall defect were recognized in the right ear. Repeated debridement obtained a smooth epithelized posterior wall with a shallow retraction. Case 3: A 28-year-old male showed right otitis media with effusion accompanying the attic wall defect and debris. Cleaning and debridement stabilized the condition of the tympanic membrane. Case 4: A 37-year-old female complained of recurrent bloody otorrhea from the left ear. Pocket-like retraction containing discharging cholesterol granulation was observed on the posterior quadrant of the left tympanic membrane. Enlargement of the pocket orifice and debridement stabilized the condition. Case 5: A 48-year-old male demonstrated a cholesterol cyst in the tympanic membrane and otitis media with effusion from the left ear. An incision was made in the cyst and a ventilation tube was inserted in the middle ear. A clear retraction pocket remained in the posterior half of the tympanic membrane.
Conservative therapy for chronic ear disease not only avoids ear surgery, but also improve the postoperative results when given as a preoperative treatment. Important aspects of this therapy were precise observation under a microscope and fine treatment using otomicrosurgical instruments.
