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[A retrospective study on cholesteatoma otitis media coexisted with cholesterol granuloma]
1Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China. keyc@tjmu.edu.cn
Insights
Cholesteatoma and cholesterol granuloma in the middle ear may stem from similar causes, like blocked ventilation and poor drainage. Bloody otorrhea in chronic otitis media patients suggests this co-occurrence.
Area of Science:
- Otolaryngology
- Pathology
Context:
- Cholesteatoma and cholesterol granuloma are distinct middle ear pathologies.
- Their co-occurrence in chronic otitis media (COM) is less understood.
- This study investigates their shared etiology and pathogenesis.
Purpose:
- To explore the common pathophysiological basis of cholesteatoma and cholesterol granuloma in COM.
- To identify diagnostic indicators and effective surgical strategies for coexisting lesions.
Summary:
- Retrospective review of 63 middle ear cholesterol granuloma cases revealed 15 with coexisting cholesteatoma.
- Both conditions were linked to chronic otitis media, ear drainage issues, and Eustachian tube dysfunction.
- Surgical intervention aimed at lesion removal and improved drainage, resulting in dry ears and improved hearing.
Impact:
- Highlights a common etiology for cholesteatoma and cholesterol granuloma, emphasizing ventilation and drainage issues.
- Suggests bloody otorrhea as a potential diagnostic clue for coexisting conditions.
- Underscores the utility of CT and MRI in preoperative diagnosis and tailored surgical approaches for better patient outcomes.
Objective:
To investigate the etiology and pathogenesis of cholesteatoma otitis media accompanied by cholesterol granuloma and the relationship between cholesteatoma and cholesterol granuloma.
Methods:
Sixty three 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 verified by surgery and pathology. Fifteen cases of cholesteatoma coexisted with cholesterol granuloma were found among the 63 patients.
Results:
All fifteen 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 ear drum (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 alternatively, and the latter lied 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, exposition of horizontal segment of facial nerve and tegmen of attic were found. Occlusion of Eustachian tube was found in 6 cases, and occlusion of tympanic isthmus was found in all cases. A post-operative dry ear was obtained, and hearing improved in all 12 cases following tympanoplasty.
Conclusions:
Cholesteatoma and cholesteatoma granuloma in middle ear may share a common pathophysiological etiology, an occlusion of ventilation and a disturbance of drainage. The diagnosis should be considered when patients with chronic otitis media presented with bloody otorrhea. CT and magnetic resonance imaging(MRI) are useful for the diagnosis before operation. The surgical approach depends on the location, extension and severity of the lesion, and the principle of surgery is to clear the lesion and create an adequate drainage.