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The prevalence and implications of marginal tympanic membrane perforations in cholesteatoma pathogenesis

Presenting Author: Leticia Rosito

Published online by Cambridge University Press:  03 June 2016

Leticia Rosito ,
Inesangela Canali ,
Sady Selaimen da Costa ,
Fabio Selaimen ,
Gabriel A. Silva ,
Livia Morsch  and
Larissa Petermann Jung
Leticia Rosito
Affiliation:
Hospital de Clínicas de Porto Alegre
Inesangela Canali
Affiliation:
Hospital de Clínicas de Porto Alegre
Sady Selaimen da Costa
Affiliation:
Hospital de Clínicas de Porto Alegre
Fabio Selaimen
Affiliation:
Hospital de Clínicas de Porto Alegre
Gabriel A. Silva
Affiliation:
Hospital de Clínicas de Porto Alegre
Livia Morsch
Affiliation:
Hospital de Clínicas de Porto Alegre
Larissa Petermann Jung
Affiliation:
Hospital de Clínicas de Porto Alegre
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Abstract

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Learning Objectives: (1) To evaluate the prevalence of marginal perforations in patients with chronic otitis media. (2) To evaluate the marginal perforations searching for signs of previous TM retraction and (3) To study the alterations in the contralateral ear.

Introduction: The pathogenesis of acquired cholesteatoma is still not completely understood. Currently, theories involving previous tympanic membrane (TM) retractions are the most accepted. Migration of the squamous epithelium across a marginal perforation of the TM has also been implicated in the development of cholesteatoma. Marginal perforations are rare events and prospective studies are also very difficult to perform since cholesteatoma is a rare disease and takes many years to develop. The study of marginal perforations and the contralateral ear (CLE) can help us to determine their implications in cholesteatoma pathogenesis.

Methods: Videotoscopy data of 1781 patients diagnosed with chronic otitis media (COM) between August 2000 and December 2015 were analyzed to determine the prevalence of marginal perforations. Signs of previous TM retraction associated to the marginal perforations were evaluated for the following: 1. medialization of the manubrium of the malleus, 2. remnant tympanum adhered to the ossicular chain, 3. remnant tympanum adhered to the promontory, and 4. ossicular chain erosion. Videotoscopy data of the CLE were also analyzed.

Results: Of the 1781 patients evaluated, 45 (2.52%) demonstrated marginal TM perforation. One thousand five hundred eighty-three patients (88.9%) showed two or more signs of previous TM retraction, while only 78 patients (4.4%) had no evidence of previous retraction. Moderate or severe TM retractions were observed in the CLE of 871 (48.9%) patients, perforationretraction in 8.9%, cholesteatoma in 13.3%, and TM perforation in 6.7% of patients. The CLE in 395 patients (22.2%) was found to be normal.

Conclusion: A low prevalence of marginal TM perforation (2.52%) was observed. The vast majority of ears with marginal perforation bore evidence of previous TM retraction. In addition, TM retraction or cholesteatoma occurred in 71.1% of the CLEs.