中耳真珠腫術後の再発性真珠腫と予防処置法

Abstract

Recurrent cholesteatoma and techniques for its prevention were studied in 52 ears in patients who had undergone closed tympanoplasty for middle ear cholesteatoma.The total incidence of recurrent cholesteatoma was 17.3%. The incidence of recurrent cholesteatoma in ears in which preventative techniques had not been performed was 33.3%, and it was 16.1% in ears in which reconstruction of scutum had been performed. Recurrent cholesteatoma was not observed in ears in which tympano-mastoid blockage had been performed, even in ears with severe retraction and adhesion of the tympanic membrane due to eustachian tube insufficiency.It was found that reconstruction of scutum cannot prevent recurrence in ears with poor postoperative eustachian tube function, though it is useful for ears with good eustachian tube function. In ears with poor eustachian tube function, we found that tympano-mastoid blockage is the most effective preventative technique against recurrent cholesteatoma.In assessing eustachian tube function, it is important to determine not only the condition of aeration but also preoperative tympanic membrane findings and intraoperative tympanic cavity findings.