真珠腫性中耳炎に対する手術

Gradingと術式め選択

抄録

Objective: Pathogenesis of middle ear cholesteatoma is unknown and how to surgically manage the disease is still controversial. We proposed in this study the surgical grading of attic cholesteatoma based on performing the canal wall up (CWU) tympanoplasty, and we showed the outcome of surgery.
Materials & Methods: 113 fresh cholesteatoma patients were operated on between July 1998 and April 2004 in our department. Non-attic types such as PSQ, congenital, and adhesive type were also included. The patients were divided into the following three groups according to the grading of the disease. The grade I group (38 ears) consists of the patients with small cholesteatoma not extending over the ossicles. The grade II group (54 ears) shows cholesteatoma involving the ossicles and extending into the mastoid cavity. The grade III group (21 ears) included large cholesteatoma destroying the bony part of the external ear canal 1/2 or more at least. For the grade I group, a one stage CWU tympanoplasty was applied. The grade II group underwent the planned staged CWU tympanoplasty. In the grade III group, canal wall down tympanoplasty was performed.
Results: Over one year after the operation, the microscopic otoscopy and CT scan revealed only one recurrence in a case in the grade I group. No recurrent case was seen in the grade II or the grade III group.
Conclusion: The very low recurrence rate (0.9%) in this study, although relatively short follow-up period, indicated that the surgical grading of cholesteatoma we proposed was appropriate and useful.