鼓膜正常な耳小骨異常 診断と治療

Abstract

In 116 ears of 106 patients with ossicular abnormalities with intact tympanic membranes, the preoperative diagnosis, differential diagnosis, operative findings and postoperative results were analyzed. The ossicular abnormalities in this study included 44 ears with otosclerosis, 48 with congenital anomalies and 22 with traumatic ossicular disruption.For the preoperative diagnosis, history taking and stapedial reflex tests were thought to be more reliable and useful diagnostic tools than tympanograms and radiological imaging.In congenital anomalies of the ossicular chain, surgeons should pay attention to auricular and facial anomalies even those of minimal degree, because there might be a close relationship between the ossicular anomaly and an auricular or facial anomaly.In traumatic ossicular disruption, history taking is indispensable and may disclose a history of minor head trauma such as falling down stairs in childhood.Reconstruction of the ossicular chain is most often successful for otosclerosis, and for traumatic disruption, but is not always satisfactory for congenital anomalies. Ossicular anomalies may be associated with other anatomical abnormalities such as facial nerve dehiscence, perilymph gusher etc. in exploratory tympanotomy. If so, the surgical results will not be satisfactory.In obtaining informed consent, all surgeons should be aware of these unexpected situations, and complete information regarding the surgical complications and the operative results should be given to the patient and his or her family.