Transcanal Endoscopic Tympanoplasty for the Treatment of Localized Eosinophilic Otitis Media in the Tympanic Cavity: A Report of Two Cases.

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.