ｏｎｌｙ ｈｅａｒｉｎｇ ｅａｒ の手術

Abstract

The management of only hearing ears remains controversial because of the risk of postoperative hearing deterioration. On the basis of our recent series of 12 only hearing ears at Hyogo College of Medicine from 1999 to 2002, we reviewed the literature and discussed indications for surgery on only hearing ears. The incidence of only hearing ears was less than 2% of ear surgeries in the literature. They comprised mainly cholesteatoma cases in English papers, and otitis media and cholesteatoma cases in Japanese papers. The causes of profound hearing loss on the contralateral ear were mainly former surgery and otitis media in English papers, and otitis media in Japanese papers. Sensorineural hearing loss was a rare cause in both papers. In our recent series, 7 ears (58.3%) showed hearing improvement (of more than 15dB), 4 ears (33.3%) remained unchanged (change within 10dB), and 1 ear (8.3%) showed hearing deterioration (of more than 15dB), which were better results than those in the previous papers. Our surgical concepts are the following: (1) In cases of chronic otitis media, we first recommend simple underlay myringoplasty, and secondly, tympanoplasty without mastoidectomy. (2) In cases of cholesteatoma, we recommend the canal wall down method, leaving matrix on the fistula. (3) When an only hearing ear shows severe combined hearing loss, we recommend informing the patient of the possible necessity of cochlear implant if hearing deteriorates after surgery. Finally, it is needless to say that skillfull surgeons should perform surgery on only hearing ears after special consideration.