小児慢性中耳炎の手術成績

Abstract

The longterm results of tympanoplasty were analyzed in 53 ears of children aged 4 to 15 years with chronic otitis media.A canal-up type I tympanoplasty was employed to 34 ears with non-cholesteatomatous chronic otitis (25 granulating otitis and 9 adhesive otitis). The rate of primary graft take (success rate of closing perforation) was 91% and the hearing results were satisfactory. The overall success rates were similar among all age groups. Consequently, tympanoplasty can be recommended in children of all ages, including preschool age.Regarding initial surgery in 15 ears with cholesteatoma, an extensive cholesteatoma filling the entire air-cell area was found in 5 ears (33%) and cholesteatoma spreading into the middle ear cleft was found in 11 ears (73%).Despite a large number of cases with active and rapidly growing cholesteatoma, complications from cholesteatoma in children were relatively low. In our series, only one case developed a complication due to wide exposure of the facial nerve.Thirteen cases with cholesteatoma extending into the attic or mastoid were treated by canal wall down procedures with canal reconstruction or mastoid obliteration. Six cases with cholesteatoma restricted to the middle ear space were treated with canal wall up procedures. At the latest follow-up ranging 4 to 52 months (average 24.5 months) after surgery, all cases were dry and maintained good anatomic results without recurrence. From these results, surgical procedures for cholesteatoma in children should be selected according to the extent of the lesion as in adults.