Fumio Nakagawa

Surgical intervention in middle-ear cholesterol granuloma

Eleven patients who had been surgically treated from 1988 to 1999 were retrospectively reviewed in order to evaluate the efficacy of ventilation tube insertion and mastoidectomy with, or without, mastoid obliteration for intractable middle-ear cholesterol granuloma. The mean age registered was 17.2 years at the time of surgical treatment. All cases were unilaterally affected. Five ears were treated with simple mastoidectomy coupled with the insertion of a ventilation tube, while six others had additional mastoid obliteration. The hearing prognosis was excellent with an improved post-operative hearing level of 16.5 dB (cf. pre-operative 37.7 dB). However, morphological prognosis revealed two ears had a residual perforated tympanic membrane without otorrhoea after displacement of the ventilation tube. Of the remaining nine ears with intact placement of the ventilation tube, five had dry ears while four had occasional otorrhoea. Although the morphological prognosis was incomplete, treatments involving at least an insertion of a ventilation tube with thorough mastoidectomy were thought to be necessary.

Labyrinthine Fistula during Chronic Ear Surgery.

Twenty cases of labyrinthine fistula have been reviewed. From 1988 to 1993, surgery was performed on 384 ears with chronic otitis media, and 20 of these cases had a labyrinthine fistula (incidence 5.2%). All twenty cases had a lateral semicircular canal fistula and one case had an additional superior semicircular canal fistula. There was no relationship between the size of the labyrinthine fistula and the incidence of vertigo or fistula symptoms. Also there was no relationship between the size of the labyrinthine fistula and preoperative bone conduction thresholds. All twenty cases were characterized by chronic otitis media with cholesteatoma, and the matrix of the cholesteatoma was completely removed in all patients with the exception one case where the cholesteatoma was enormous. Preoperative bone conduction hearing was preserved after removal of the cholesteatoma matrix in all cases except the latter.These results suggest that lesions over the lateral semicircular canal fistula should be completely removed, at best with care, when they are discovered during chronic ear surgery. This policy rarely causes lateral semicircular canal fistula bone conduction hearing to become worse.