上鼓室型真珠腫に対するcanal wall up法による一期的手術

抄録

Our purposes of surgical treatment for attic cholesteatoma are 1) complete removal or cnolesteatoma, 2) retainment of aerated tympanic and mastoid cavity, 3) hearing improvement by reconstruction of the tympanic membrane and ossicular chain, 4) preservation of function and morphology of the external and middle ear. Recently the number of cholesteatoma cases with otorrhea and granulation tissue is decreasing, and the number of cholesteatoma cases with well-aerated tympanic cavity and no granulation tissue in the mastoid cavity is increasing, by the development of antibiotics or the improvement of sanitary condition. Twenty-nine ears of 26 cases with attic cholesteatoma underwent canal wall up tympanoplasty with scutumplasty and onestage ossicular chain reconstruction during 1992-2001. We discussed the indication, complication, and hearing result of the cases operated by this method. The essential points of this operation are summarized as follows: 1) spread of the tympanic isthmus by anterior tympanotomy and posterior hypo tympanotomy, 2) attention to preserve the tympanic membrane and the tympanic annulus, 3) preservation of the manubrium of the malleus, 4) scutumplasty by using cartilage. Canal wall up tympanoplasty in this method consequently concludes in restricted defect of tympanic membrane, and so early epithelization is obtained after operation. We provide answer for the patient who requests hearing improvement by operation or shortening of duration of admission.