第78回日耳鼻総会学術講演会パネルディスカッション: 鼓室成形術の再評価その禁忌と適応

抄録

Indications and contraindications to tympanoplasty were discussed and classified based upon surgeon's technical skill as follows:
I) Contraindications
a) Absolute contraindications -Patients who should be rejected even by skilled surgeons.-1) No cochlear reserve or severe sensorineural hearing loss. 2) Systemic diseases. 3) Non-patent eustachian tube. 4) Haemorrhagic diathesis. 5) Associated intracranial complications or apecitis. 6) Psychosis or psychoneurosis. 7) One-hea-ringear. 8) Age factor (children under 5 years; 60 years and older patients). 9) Long discharging ears due to non-sensitive bacteria. 10) Cleft palate patient and postoperative case. 11) Associated nasal allergy.
b) Relative contraindications-Staged operations should be recommended.-1) Large area of absent mucosa in tympanum. 2) Ears in which removal of pathology is in danger of inner ear lesions. 3) Fixation of foot plate. 4) Cholesteatosis in children. 5) Questionable removal of cholesteatoma. 6) Ears in which primary ossiculoplasty is not suitable.
II) Relative indications-Trainees should not do tympanoplasty.-1) Tubal insufficiency. 2) Mixed deafness. 3) Multioperated or severely destroyed ears. 4) Patients with chronic otitis externa, septal deformity, chronic paranasal sinusitis etc. 5) Discharging ears. 6) Associated labyrinthine fistula with cholesteatoma matrix difficult of removal. 7) Ears with otogenic complication. 8) Fixed stapes due to tympanosclerosis.