Wake Kokushi, Miyashita Takenori, Takahashi Satoshi, Hoshikawa Hiroshi
Department of Otolaryngology, Faculty of Medicine, Kagawa University, Miki, JPN.
Department of Otolaryngology, Takamatsu Red Cross Hospital, Takamatsu, JPN.
Cureus. 2025 Aug 18;17(8):e90405. doi: 10.7759/cureus.90405. eCollection 2025 Aug.
Eosinophilic otitis media (EOM) is a form of refractory otitis media characterized by eosinophil-dominant, highly viscous middle ear effusion, for which tympanoplasty is generally contraindicated. In patients with well-controlled otorrhea who do not require transtympanic therapy, tympanic membrane closure may significantly improve clinical severity scores and reduce the risk of infection. We report two cases of EOM localized to the mesotympanic and hypotympanic cavities that were successfully treated with transcanal endoscopic tympanoplasty without the use of biologics. In both cases, the procedure improved hearing and severity scores, resolved otorrhea, suppressed infection, and alleviated mucosal irritation in the middle ear. Reconstruction of the tympanic membrane using auricular cartilage helped prevent adhesion to mucosal defect regions in the middle ear. These cases suggest that transcanal endoscopic tympanoplasty may be effective in the absence of complications such as chronic eosinophilic rhinosinusitis in patients with well-controlled otitis media and localized mucosal lesions. This report demonstrates the potential applicability of tympanoplasty in selected patients with EOM, despite traditional contraindications. Furthermore, it highlights the effectiveness of combining three antiallergic agents (ibudilast, montelukast, and cetirizine) in controlling postoperative eosinophilic inflammation.
嗜酸性粒细胞性中耳炎（EOM）是一种难治性中耳炎，其特征为嗜酸性粒细胞为主、高黏稠度的中耳积液，对此通常禁忌进行鼓室成形术。对于耳漏得到良好控制且不需要经鼓膜治疗的患者，鼓膜封闭术可显著改善临床严重程度评分并降低感染风险。我们报告两例局限于中鼓室和下鼓室腔的EOM患者，经耳道内镜鼓室成形术成功治疗，未使用生物制剂。在这两例患者中，该手术改善了听力和严重程度评分，解决了耳漏问题，抑制了感染，并减轻了中耳黏膜刺激。使用耳郭软骨重建鼓膜有助于防止中耳黏膜缺损区域发生粘连。这些病例表明，对于中耳炎得到良好控制且存在局限性黏膜病变的患者，在没有慢性嗜酸性粒细胞性鼻-鼻窦炎等并发症的情况下，经耳道内镜鼓室成形术可能有效。本报告证明了鼓室成形术在部分EOM患者中的潜在适用性，尽管存在传统禁忌证。此外，它突出了联合使用三种抗过敏药物（异丁司特、孟鲁司特和西替利嗪）控制术后嗜酸性粒细胞炎症的有效性。
