Management and graft outcomes of chronic tympanic membrane perforation with isolated malleus cholesteatomas.

OBJECTIVE

This study aimed to evaluate the graft outcomes of endoscopic cartilage-perichondrium underlay myringoplasty, without raising the tympanomeatal flap, for managing chronic central perforation associated with isolated malleus cholesteatomas.

MATERIALS AND

METHODS

Twenty-three patients with chronic perforation and isolated malleus cholesteatomas underwent endoscopic cholesteatoma removal followed by cartilage underlay myringoplasty. The graft success rate, hearing improvement, and recurrence of cholesteatoma were assessed at 24 months postoperatively.

RESULTS

Intraoperative findings in all 23 patients revealed the accumulation of keratin debris in the superior part of the tympanic membrane perforation around the tip of the malleus handle. Histopathological analysis confirmed the presence of squamous epithelium with keratin debris in all cases. All grafts were successful, and complete closure of the perforations was achieved at the 24-month follow-up. Postoperative pure-tone average air conduction thresholds improved significantly from 56.2 ± 11.6 dB to 43.4 ± 16.6 dB (P < 0.05, paired-sample t-test). Similarly, the air-bone gap (ABG) improved from 35.8 ± 8.2 dB to 19.7 ± 10.5 dB, with a significant difference (P < 0.05, paired-sample t-test). The average ABG gain was 16.1 ± 6.6 dB. No recurrence of cholesteatoma was detected through computed tomography or endoscopic examination during the 24-month follow-up period.

CONCLUSIONS

Endoscopic removal of malleus cholesteatomas combined with cartilage graft underlay myringoplasty, without raising the tympanomeatal flap, demonstrated a high rate of graft success and significant hearing improvement in patients with chronic perforation and isolated malleus cholesteatoma. No recurrence of cholesteatoma was observed during the two-year follow-up.