抄録
Impairment of function and obstruction of the tympanic orifice of the eustachian tube are more common in patients with adhesive otitis media than in those with other forms of chronic otitis media. Moreover, in patients with adhesive otitis media the middle ear mucosa is also damaged. Therefore, the results of tympanoplasty are poor. To cope with this difficulty, we tried various surgical approaches, but in the past 69 cases of adhesive otitis media (total adhesion) hearing was improved only 45%. In addition to the presence of tubal dysfunction, the following is thought to be a cause of this poor result. In association with abrasion of the adherent tympanic membrane, the mucosa of the tympanic promontory is lost resulting in exposure of a broad surface of bone, and the delay in postoperative epithelization of the middle ear cavity causes impairment of the ciliary function of the middle ear mucosa and reduces transmucosal gas exchange. Therefore, we now think it is important to facilitate early regeneration of middle ear mucosa, as well as to assure aeration in the middle ear cavity immediately after operation. For this reason, in patients with total ear drum adhesion we attempt to minimize exposure of middle ear bone surface as much as possible. We perform tympanoplasty and insert a ventilation tube to the fascia. In some patients, a silastic sheet is placed in the middle ear cavity. In patients with extensively exposed bone surface in the middle ear cavity, we graft mucosa from the inferior nasal concha onto the bone surface to facilitate epitheliazation.
