Cholesterol granuloma of the middle ear in post-irradiated nasopharyngeal carcinoma patients.

BACKGROUND/AIMS: To evaluate the surgical outcome of tympanoplasty with mastoidectomy for cholesterol granuloma of the middle ear in post-irradiated patients with nasopharyngeal carcinoma (NPC).

METHODS

Nine post-irradiated NPC patients diagnosed with cholesterol granuloma in a single-sided middle ear were included in this study. The time from radiotherapy termination to surgery ranged from 6 to 14 years (median 9 years). All patients underwent radical tympanoplasty with canal wall down or up mastoidectomy.

RESULTS

All the patients with NPC received radiotherapy of 68-75 Gy before surgery. Three ears underwent tympanoplasty with canal wall down mastoidectomy, and 6 ears underwent tympanoplasty with canal wall up mastoidectomy. All the patients were followed up for at least 2 years. Seven ears (77.8%) had an intact tympanic membrane and 2 ears developed re-perforation of the eardrum 3 months after surgery, but otorrhea decreased significantly. All these patients reported improved quality of life after surgery. Before the operation, the pure tone averages (0.25, 0.5, 1, 2 kHz) were 90.5 dB and the air-bone gaps (0.5, 1, 2 kHz) were 45.8 dB (vs. 62.3 and 25.5 dB, respectively, at 6 months after the operation).

CONCLUSIONS

Most post-irradiated NPC patients with cholesterol granuloma of the middle ear benefit from this surgery. Chronic otitis media caused by radiotherapy is not a contraindication to tympanoplasty.