Middle Ear Cholesterol Granuloma Research Articles

Symptoms: Purple Ear Drum and Hearing Loss

Symptoms: Purple Ear Drum and Hearing Loss

Analysis of surgical effect on middle ear cholesterol granuloma

Objective:To evaluate surgical effects on middle ear cholesterol granuloma（CG）. Method:The patients receiving surgery due to middle ear CG were retrospectively analyzed. The choice of operative methods was made according to medical history, endotoscope, pure-tone audiometry and temporal bone CT. Tympanostomy tube（TT） insertion was performed on 12 patients; canal wall up（CWU） tympanoplasty combined with tympanostomy tube was performed on 40 patients, and canal wall down（CWD） tympanoplasty combined with TT on 14 cases. The pre-and postoperative audiometric results（500, 1000, 2000 and 4000 Hz） were evaluated for each patient. Then the average air-bone gap（ABG） was analyzed. Result:One patient had postoperative tube obstruction. One patient who performed only TT insertion recurred. Secretory otitis media occurred in one case undergoing CWU tympanoplasty after removal of the ventilation tube. For TT insertion group, pre-and postoperative ABG levels were （21.25±5.96） dB and （8.85±6.49） dB, respectively（P<0.01）. For CWU+TT group, pre-and postoperative ABG levels were （34.19±10.43） dB and （23.55±12.48） dB, respectively（P<0.01）. For CWD+TT group, pre-and postoperative ABG levels were （36.43±12.11） dB and （25.71±13.50） dB, respectively（P<0.01）. Conclusion:The aim of surgical treatment for middle ear CG includes thorough removal of lesions, improvement of ventilation and drainage of middle ear. Individualized surgical strategy should be adopted according to the patients' conditions. And long-term follow-up should be done after operation.

Canalplasty: surgical technique and analysis of the results

Objective:To determine the applications and results of canalplasty for closed middle ear surgery.Method:Charts of 74 ears who underwent a canalplasty and closed middle ear surgery because of chronic otitis media or middle ear cholesterol granuloma between 2012 and 2016 were reviewed for general condition, disease, surgery methods,surgical outcome,complications,results of pure tone audiometry pre-and post-operatively.Result:Sixteen(21.6%) ears have some problems of their anterior ligament of malleus.Post-operative there are 69 ears totally epithelization, of which the rate is 93.2%,and the average epithelization time is 5.3 weeks. The myringoplasties are successful on 72 ears(97.3%).There are 5 ears(6.8%) occurring complications relating to canalplasty.One year after surgery the air-bone gap has decreased by 8 dB, which has been improved significantly than pre-operative(P<0.05).Conclusion:This study shows that technique for canalplasty is safe and effective,which can exposure the whole tympanic membrane and is easy for tympanoplasty. The epithelization rate of our technique is high.And it's good for myringoplasty and hearing outcomes.

Cholesterol granuloma associated with otitis media in a cat

An 8-year-old, male neutered Siamese cat was presented with Horner syndrome and right head tilt. A soft tissue mass was observed in the right tympanic cavity, and bulla osteotomy was performed. Tissue samples retrieved from the tympanic cavity were sent for histology, and a middle ear fluid swab was sent for bacterial culture and sensitivity. Histologic diagnosis was of otitis media associated with cholesterol granuloma (CG). Bacterial culture yielded Pasteurella multocida and Leifsonia (Corynebacterium) aquaticum. Middle ear CG is frequently seen in human beings and is associated with a variety of middle ear diseases including otitis media. Cholesterol granuloma of the middle ear has been experimentally induced in cats. The clinical and pathological findings of a spontaneous case of CG in the tympanic cavity of a cat with otitis media are described herein.

Analysis of surgical treatment for middle-ear cholesterol granuloma

Cholesterol granuloma is an intractable ear disease. Many studies of this condition have been published since the initial report by Manasse. However, the pathogenesis of this condition is unclear. This study reviewed the treatment of middle-ear cholesterol granuloma in 16 patients undergoing surgical treatment at Kurume University Hospital.The relationship between patients' pre-operative tympanic membrane findings and post-operative course was analysed. Patients with swollen tympanic membranes had significantly poorer outcomes. Patients with retracted tympanic membranes and those undergoing ossicular chain reconstruction had significantly better outcomes. The patients' overall hearing success rate at approximately two weeks post-operatively was 75 per cent. However, by six months post-operatively, the overall hearing success rate had declined to 62.5 per cent. Patients with poor hearing two weeks post-operatively did not acquire better hearing.

Bilateral middle ear cholesterol granuloma in familial hypercholesterolemia

Cholesterol granuloma (CG) is a histologic description of foreign body giant cell formation toward cholesterol crystals. The majority of temporal bone CG is unilateral and most common in the petrous apex. Middle ear CG is usually the result of underlying ear diseases. Primary middle ear CG is very rare. Most reported CG has not been associated with familial hypercholesterolemia (FH). FH, an autosomal dominant disorder, manifests as high levels of serum cholesterol and low density lipoprotein (LDL) cholesterol. We report a rare case of FH and bilateral aggressive primary middle ear CG. This publication has been approved by the IRB, Hospital Alor Setar.

コレステリン肉芽腫に対する手術症例の検討―術前所見と経過との関連―

Middle ear cholesterol granuloma is still an intractable ear disease, and its pathogenesis has not been clearly demonstrated. In this study, we evaluated treatment of middle ear cholesterol granuloma.We reviewed middle ear cholesterol granuloma in 16 ears that underwent surgical treatment at Kurume University Hospital between 1990 and 2006.Cases that were healed by ventilation tube insertion only and those combined with other middle ear disease such as cholesteatoma were excluded from this study. We analyzed the relation between preoperative findings of the tympanic membrane and postoperative course. Preoperative findings of the tympanic membrane were grouped into the swollen type or retracted type. The cases that underwent myringotomy more than twice, showed persistent otorrhea from the tympanic ventilation tube, or the ventilation tube was missed were classified as showing a poor postoperative course. Cases without the above symptoms were classified as showing a good postoperative course. The hearing results were analyzed using the Guidelines for Evaluating Hearing Results after Middle Ear and Mastoid Surgery published by the Otological Society of Japan (2000).The postoperative courses of patients with a swollen tympanic membrane were significantly poorer. The postoperative courses of those with a retracted tympanic membrane and those undergergoing ossicular chain reconstruction showed significantly better results. However, 3 of 4 cases showing swollen tympanic membrane achieved a good passage. Such cases underwent posterior tympanotomy with ossicular chain reconstruction.Success rate for hearing improvement at about 14 post operative days was 75%. Yet, beyond 6 months postoperatively, the success rate deteriorated to 62.5%. Cases showing a poor hearing result at 14 postoperative days never showed a permanently improved hearing result.To acquire better postoperative results in patients with swollen tympanic membrane, posterior tympanotomy with ossicular chain reconstruction is highly recommended.

A large and uncharacteristically aggressive cholesterol granuloma of the middle ear

Cholesterol granulomas of the middle ear tend to be benign in nature, frequently seen by otologists during cholesteatoma or chronic otitis media surgery and easily dealt with by evacuation. In contrast, cholesterol granulomas of the petrous apex appear to have a more aggressive nature and present significant pathological threats. We present a case of a large destructive cholesterol granuloma of the middle ear eroding the middle and posterior cranial fossa bone and dura to exert a mass effect upon the temporal lobe. We emphasize the destructive potential of this extremely rare middle-ear cholesterol granuloma, and draw attention to the distinction between this variant and the commonplace and benign form of the lesion more usually found at this site. We also present the current theories of the aetiology of cholesterol granuloma formation with possible explanations for the rare aggressive behaviour.

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.

A retrospective study on cholesteatoma otitis media coexisting with cholesterol granuloma.

To investigate the etiology and pathogenesis of cholesteatoma otitis media accompanied by cholesterol granuloma and the relationship between cholesteatoma and cholesterol granuloma, 63 cases of middle ear cholesterol granuloma treated in our hospital during the period from March 1988 to May 2000 were retrospectively reviewed. All cases were surgically and pathologically verified. 15 cases of cholesteatoma coexisting with cholesterol granuloma were found among the 63 patients. All 15 cases had a long-term history of otitis media, such as otorrhea (sanguine purulent otorrhea and bloody otorrhea in 8 cases) and perforation of the eardrum (perforation of pars flaccida in 8 cases). Temporal bone CT scans showed cholesteatoma in 11 cases. All patients were treated surgically, and cholesteatoma and cholesterol granuloma were found coexisting alternately, the latter lying mainly in the tympanic antrum, attic and mastoid air cells. Chocolate-colored mucus was accumulated in well-developed mastoid air cells, and glistening dotty cholesterol crystals were also found. In most cases, enlarged aditus, destruction of lateral attic wall, erosion of ossicular chain, exposure of horizontal segment of facial nerve and tegmen of attic were observed. Occlusion of Eustachian tube was noted in 6 cases, and occlusion of tympanic isthmus was revealed in all cases. A post-operative dry ear was achieved in all patients, and hearing improvement was achieved in all 12 cases following tympanoplasty. Cholesteatoma and cholesterol granuloma in middle ear may share a common pathophysiological etiology: occlusion of ventilation and disturbance of drainage. The diagnosis should be considered when patients presented with chronic otitis media with bloody otorrhea. CT and magnetic resonance imaging are useful for the diagnosis before operation. The surgical approach depends on the location, extension and severity of the lesion. The purpose of surgery is to remove the lesion and create an adequate drainage.

中耳コレステリン肉芽腫の新しい治療 ステロイド内服と鼓膜チューブ留置

A combination of oral Prednisolon and ventilation tube insertion was tried in 5 patients (6 ears) with the primary middle ear cholesterol granuloma manifesting blue eardrums. The patients, aged 6 to 19 years, were given 0.5-4mg/kg of body weight of oral prednisolon tapered over 10 to 14 days, and a ventilation tube was inserted during or immediately after the course of prednisolon. All 6 middle ears have been dry and well ventilated with the ventilation tubes in position with good hearing for 4 to 31 months, and CTs have revealed good aeration of the mastoids. Three courses of this therapy were required to obtain a dry middle ear in 1 of the 6 ears, but only 1 course was necessary in the remaining 5 ears. No serious side effects of this therapy were observed except for transient steroid acne in 1 patient. This combination therapy was considered to be worth trying in the treatment of the middle ear cholesterol granuloma.

The surgical indication and hearing prognosis of middle ear cholesterol granuloma with blue ear drums

The surgical indication and hearing prognosis of middle ear cholesterol granuloma with blue ear drums