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Objectives: To compare the results obtained with canal wall up (CWU) tympanoplasty for cholesteatoma using cartilage or an hydroxyapatite (HA) PORP positioned on the head of the stapes and to analyse the impact of malleus removal and total reinforcement of the tympanic membrane with cartilage., Materials and Methods: Retrospective study of 128 cases (99 adults, 29 children) operated between 2003 and 2012 for cholesteatoma by CWU tympanoplasty with use of a cartilage graft (90 cases) or a PORP (38 cases) on the head of the stapes. Audiometric results were analysed according to the International Bureau for Audiophonology (BIAP) criteria and were submitted to statistical analysis. All ossiculoplasties were performed during the first operation and only 39% of patients required surgical revision. The malleus was preserved in 79 cases and sacrificed in 49 cases., Results: With a follow-up of 2 years, the residual mean air-bone gap was 16.8 dB in the cartilage group (gain of 7.6 dB; P = 0.001) and 15.8 dB in the PORP group (gain of 8.5 dB; P = 0.002). The air-bone gap was less than 20 dB in 67.6% of cases in the cartilage group and 70.4% of cases in the PORP group. No significant difference was observed between the 2 techniques and no significant difference was observed according to whether or not the malleus was preserved in either the cartilage group or the PORP group., Conclusion: These results confirm the value of cartilage graft placed on the head of the stapes as ossiculoplasty technique in cholesteatoma operated by CWU tympanoplasty, giving comparable results to those obtained with a PORP. Malleus removal did not induce any reduction of the quality of hearing obtained. Total reinforcement of the tympanic membrane with cartilage appeared to decrease the cholesteatoma recurrence rate (8.5%)., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Tympanoplasty now frequently uses cartilage to repair bone lysis in the external auditory canal (EAC) and to reinforce the tympanic membrane. Once in place, however, the cartilage may complicate ossiculoplasty by obstructing visualization of the stapedial region. Posterior tympanotomy, when included in the tympanoplasty procedure, may provide an interesting means of positioning the ossiculoplasty., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

This study analyzes the morphological and hearing results obtained with cartilage tympanoplasty in retraction pocket, blunting and tympanic membrane lateralization, and cholesteatoma surgeries. Results obtained 3 years postoperatively in 80 patients operated on with cartilage reinforcement of the tympanic membrane (TM) were compared with those obtained 3 years postoperatively in 100 patients operated on with fascia or perichondrium TM reinforcement. Retraction pocket recurrence was found in the patients operated on with fascia or perichondrium in 24% of cases and only in 8% of cases in patients operated on with partial tympanic membrane cartilage reinforcement. No recurrence was found in patients operated on with a total reinforcement of the TM. Cartilage tympanoplasty with skin graft covering the bony external auditory canal (EAC) was performed in 6 cases of severe blunting and/or tympanic membrane lateralization. 3 years post-operatively, good morphological and functional results were obtained in 3 cases. One or two staged ICW procedures were performed in 390 adult patients (416 ears) suffering from a non operated middle ear cholesteatoma. Recurrent and residual cholesteatoma rates were evaluated. Cholesteatomas were operated on with removing the malleus, reinforcing all the tympanic membrane with cartilage and performing an ossiculoplasty with hydroxylapatite prosthesis. The results were compared to those obtained in ICW cholesteatoma surgery with preserving the malleus manubrium, partially reinforcing the eardrum with cartilage and predominantly using an ossicle to perform the ossiculoplasty. Removing the malleus and reinforcing the whole tympanic membrane with cartilage statistically reduced the cholesteatoma recurrence rate for the ICW procedure. This technique, using hydroxylapatite prosthesis for ossiculoplasty gives good hearing results.

Certain fixed adherent retraction pockets especially in the posterior aspect of the tympanic cavity and certain cholesteatomas are difficult to treat even after a posterior tympanotomy has been performed. Using 70 degrees and especially 30 degrees optical systems can be of great value as the lesions can be perfectly visualised and endoscopic copho-surgery itself can even be carried out. Study of 27 cases of fixed retraction pockets and 14 cholesteatomas which underwent microscopic surgery but with optical verification of the operative cavity demonstrated the value of this technique. The safety of the method even allows the exclusive use of the endaural route in cases which have up to now required a posterior approach and posterior tympanotomy.

Summary: Objectives: To report a second case of cholesterol granuloma of the middle ear invading the cochlea. Material and methods: A 54-year-old woman, who had undergone right-side tympanoplasty with stapedectomy, complained of intermittent right-side otorrhea associated with cophosis. Otomicroscopy found anterior eardrum perforation with mucopurulent effusion. Computed tomography (CT) showed a lesion filling the tympanic cavity, exposing the tympanic facial nerve, with destruction of the ossicles; the vestibule and cochlea were ossified except for the basal turn. The petrous apex was normal. Magnetic resonance imaging (MRI) showed invasion of the cavity and basal turn of the cochlea by a mass in heterogeneous hypersignal on T-1 weighted images, non-enhanced by gadolinium injection, and hyperintensity on T2-weighted images. Cholesterol granuloma of the middle ear was suspected, with surgery indicated due to the facial nerve exposure and cochlear invasion. Results: A brownish-yellow compressive mass invading the basal turn of the cochlea, suggestive of cholesterol granuloma, was removed. Histologic examination confirmed diagnosis. Conclusion: Direct invasion of the otic capsule by cholesterol granuloma is extremely unusual. Surgery is indicated in such cases, to avoid onset of neurologic complications. [Copyright &y& Elsevier]