[Clinical outcomes of surgical management in 19 cases of tympanic paraganglioma].

Objective: To summarize the clinical experience and to evaluate the long-term outcomes of individualized surgical management for tympanic paraganglioma based on the modified Fisch-Mattox classification. Methods: A retrospective analysis was conducted on 19 patients (19 ears) with tympanic paraganglioma who underwent surgical treatment at our institution between 2014 and 2024. The cohort included 1 male and 18 female patients, with a mean age of 50 years (range, 36-75 years). There were 9 left ear cases and 10 right ear cases, with a disease course of 15 days to 6 years. Individualized minimally invasive surgical plans were formulated according to the modified Fisch-Mattox classification, including 3 cases of type A1, 3 cases of type A2, 10 cases of type B1, and 3 cases of type B2. All surgeries were performed with combined endoscopic and microscopic techniques. Patients were followed up for 1 to 10 years (median, 5.6 years). Intraoperative indicators, pre-and postoperative hearing levels, complications and long-term follow-up data were collected and analyzed using SPSS 27.0 software. Results: Otoendoscopic surgery via the transcanal approach was performed in 15 patients (3 type A1, 1 type A2, 8 type B1 and 3 type B2). The remaining 4 patients underwent microscopic surgery: 2 type A2 patients received transcanal surgery, and 2 type B1 patients were managed via the combined transmastoid-transcanal approach. Complete tumor resection was achieved in all 19 patients, with no recurrence observed during follow-up. Pure-tone averages were calculated at 0.5, 1.0, 2.0 and 4.0 kHz. The mean postoperative air-bone gap was improved by 10.0 dB (18.0 dB preoperatively vs 8.0 dB postoperatively, P=0.005). Patients with type A tumors obtained a greater median improvement of air-conduction threshold than those with type B tumors (17.0 dB vs 10.0 dB, P=0.020). Postoperative complications occurred in 9 patients, including 2 type A2, 4 type B1 and 3 type B2 cases, with type B2 tumors showing the highest complication rate. All complications were successfully relieved or controlled after targeted treatment, and all patients achieved favorable long-term prognoses. Conclusion: Surgical treatment yields satisfactory long-term outcomes for tympanic paraganglioma. Surgical strategies should be individualized. The transcanal otoendoscopic approach is a safe and effective minimally invasive technique for patients with type A and B1 tumors. Although transcanal otoendoscopic surgery can achieve radical tumor resection for type B2 lesions, a combined endoscopic-microscopic approach may provide a more balanced and efficient surgical option.