FP01-7. SURGICAL TREATMENT WITH MODIFIED RADICAL MASTOIDECTOMY FOR THE INTRACTABLE CASES OF TYMPANOMASTOID CHOLESTEROL GRANULOMA

Kai-Chieh Chan, Che-Ming Wu (Chang Gung Memorial Hospital, Taiwan)

Objectives: The treatment of tympanomastoid cholesterol granuloma (CG) still remains controversial to date. Most authors agree that treatment for cases with tympanomastoid CG is conservative, consisting of observation or myringotomy with insertion of ventilation tubes. However, it is troublesome to manage the intractable cases of tympanomastoid CG such as persistent bloody otorrhea, chronic otitis media coexisting with CG or bluish bulging mass from middle ear with conservative methods. In this article, we attempt to discuss if the aggressive surgery with modified radical mastoidectomy is suitable for treatment of the intractable cases of tympanomastoid CG.

Methods: From August 1999 to March 2004, 9 cases (11 ears) tympanomastoid CG were enrolled in this retrospective study. The manifestations mainly include hearing loss, aural fullness, hemotympanium and bloody otorrhea. All of the cases were treated with modified radical mastoidectomy with wide meatoplasty and were verified by surgery and pathology.

Results: The mean age registered was 41.1 years old at the time of surgical treatment. Hearing loss (11 ears, 100%) and aural fullness (11 ears, 100 %) were the most prominent manifestations in our series. Bloody otorrhea (6 ears, 55 %), hemotypanium (6 ears, 55%) and bluish bulging mass from middle ear (4 ears, 36%) were other presentations. Lesions in all cases were found to locate in the mastoid, attic and antrum during the operation. In addition, the ossicular chain was intact without destruction in 10 ears except 1 ear. The average duration of post-operative follow-up was 27 months. All but 1 (10%) post-operative ears were free from recurrence. Most post-operative ears revealed dry appearance but 1 ear had occasional otorrhea. The hearing prognosis was excellent with improved post-operative hearing level of 47dB (cf. pre-operative 57dB).

Conclusions: Not only the lesion could be eliminated and aerated but also the clinical symptoms could be improved by the aggressive surgery in our series. Therefore, treatment with modified radical mastoidectomy for the intractable cases of tympanomastoid CG might be necessary.

 * Contact person email: kjchan@adm.cgmh.org.tw