Cartilage-Perichondrium Myringoplasty for Managing Intratympanic Membrane Cholesteatomas With Chronic Otitis Media in Adults

Abstract

Objective: This study evaluated the surgical outcomes and complications of the endoscopic cartilage-perichondrium graft technique for treating intratympanic membrane cholesteatomas (ITMCs) with tympanic membrane (TM) perforation or an atrophic TM in adults. Methods and Materials: Clinical data on 11 adult ITMCs were analyzed retrospectively. The graft success and cholesteatoma recurrence were evaluated 12 months postoperatively. Results: Of the 11 patients with ITMC, TM perforation had occurred in 2 (18.2%) and an atrophic TM or TM scar healing occurred in 9 (81.8%). In endoscopy, keratin debris accumulation was seen at the superior edge of the perforation or atrophic TM. Computed tomography revealed that the cholesteatoma was confined to the TM. Intraoperatively, the epithelial invasion of the cholesteatoma was limited to the fibrous layer within the TM. Cartilage-perichondrium grafting was performed after removing the cholesteatoma. All the grafts were successful, and the perforations achieved complete closure by the final 12 month follow-up. Endoscopy revealed no recurrent cholesteatoma. Of the 9 patients with preoperative tinnitus, the tinnitus disappeared in 3 (33.3%), was relieved in 4 (44.4%), and was unchanged in 2 (22.2%). Of the 7 patients with an ear fullness preoperatively, the ear fullness disappeared in 6 (85.7%) and was relieved in 1 (14.3%). The mean air-bone gap improved from 28.6 dB preoperatively to 16.2 dB postoperatively. Conclusions: Endoscopic complete excision of an ITMC and cartilage-perichondrium graft without raising a tympanomeatal flap can lead to successful graft intake and improve the symptoms for the patients with ITMC combined with perforation or atrophic TM.