(094) CO2 Laser Ablation of a Tympanic Membrane Hemangioma

Introduction: We report a case of a hemangioma limited to the lateral surface of the tympanic membrane (TM) and present an effective technique of management.

Methods: Study

Design: Case report

Setting: Tertiary referral center

Patient: A 40-year-old female with a history of recurrent otitis media necessitating tympanostomy tube placement as a child presented to clinic with concerns about an abnormal appearing right TM. Otomicroscopy demonstrated a vascular-appearing lesion at the central portion of the lateral TM consistent with a hemangioma. CT scan showed a soft tissue mass arising from the lateral surface of the right TM without middle ear involvement.

Interventions: CO2-laser ablation of a vascular lesion on the right TM followed by a cartilage push-through tympanoplasty to repair the resultant perforation.

Main Outcome Measures: Final lesion pathology, postoperative healing of the TM, and postoperative audiometric outcomes.

Results: Excisional biopsy was performed in the operating room. A CO2 continous wave laser was used to induce contraction of the TM lesion. The lesion was then carefully peeled off the tympanic membrane and sent en block for pathology. A small perforation was noted immediately following laser ablation which was repaired using a cartilage push-through tympanoplasty. Final pathology was consistent with hemangioma of the TM. At the 1-month post-operative follow-up, otomicroscopy demonstrated no evidence of residual hemangioma and a well-healed perforation. An audiogram performed at that time revealed full preservation of hearing.

Conclusions: Hemangioma isolated to the tympanic membrane is an extremely rare condition with only a handful of cases reported in the literature. Our case illustrates how CO2 laser ablation is a safe and effective technique for lesion ablation without any detrimental effects on post-operative healing of the tympanic membrane, audiometric outcomes, or resistance to recurrence.