Transcanal endoscopic excision of early-stage middle ear paragangliomas

To describe patient-level hearing and symptom outcomes after exclusive transcanal endoscopic ear surgery (TEES) for early-stage middle ear paragangliomas.

This retrospective case series included nine consecutive patients with Glasscock-Jackson stage I-II tumors treated between January 2019 and September 2023. Air-conduction (AC) and bone-conduction (BC) pure-tone averages and air-bone gaps (ABGs) were assessed preoperatively and at 6 months. A decrease of at least 10 dB in AC pure-tone average defined hearing improvement.

Mean AC pure-tone average decreased from 52.3 ± 18.0 to 34.4 ± 15.0 dB and mean ABG from 31.3 ± 8.0 to 13.0 ± 4.6 dB; mean BC pure-tone average remained stable (21.0 ± 13.7 vs. 21.4 ± 13.4 dB). Eight patients improved, one remained stable, and none worsened. Pulsatile tinnitus was present in eight patients and resolved in all. Two limited tympanic membrane defects were repaired with temporalis fascia; both healed without delayed perforation. No conversion, facial nerve dysfunction, transfusion, or other major perioperative complication occurred. No clinically evident residual or recurrent disease was identified after a mean follow-up of 16.1 ± 7.9 months (range, 10-36 months).

Exclusive TEES provided clinically meaningful conductive hearing improvement, stable BC thresholds, and complete tinnitus resolution in this selected series. Immediate temporalis fascia repair provided durable membrane closure when needed.