真珠腫性中耳炎手術と術後経過の検討

Abstract

Surgical findings and results in 115 cases of middle ear cholesteatoma were analyzed. In 21 cases of planned staged tympanoplasty, residual cholesteatoma was found in 43% at the second-stage of surgery. In 94 cases of one-stage tympanoplasty, residual or recurrent cholesteatoma was found in 6%. Attic retraction pocket which was considered a precurser of recurrent cholesteatoma was found in 23% during the postoperative course. To avoid a residual cholesteatoma and to maintain the original shape of the external auditory canal, cholesteatoma should be removed by an open-and-closed method in one-stage tympanoplasty. However, staged tympanoplasty is recommended in difficult cases. Furthermore, mastoid obliteration is useful to avoid recurrent cholesteatoma and attic retraction pocket.In cases that were followed for more than 6 months, hearing improvement (postoperative hearing level within 40 dB or an Air-Bone gap within 20 dB or hearing gain over 15 dB) was obtained in 91% for type III and 43% for type IV. The incus, malleus, cartilage and plastipore PORP were used as columella materials in type III tympanoplasty and good hearing results were obtained with all of them. In type IV tympanoplasty, good hear-ing results were obtained by plastipore TORP. The extrusion rate of PORP and TORP was 29%. It was concluded that more effective means for preventing extrusion of columella are necessary, and that the use of PORP and TORP should be restricted especially in cases with severe middle ear lesions.