高齢者真珠腫の病態と手術適応

抄録

Clinical features of cholesteatoma in patients over 60 years of age were studied. Tympanoplasty wascarried out in 30 ears of 29 patients, including 13 males and 16 females at our hospital during the periodfrom 1981 to 1990. The mean age was 65 years old, the oldest patient was a 76-year-old female.
Chief complaints were as follows; otorrhea in 14 cases, dizziness or vertigo in 9 cases, tinnitus in5cases, and facial palsy in one case. They had no complaints of hearing loss even when their hearing losseswere demonstrated objectively on admission. Episodes of recurrent otitis in childhood were reported by 19 of the patients (66%).
Cholesteatomas were classified into four types, namely attic cholesteatoma in 18 ears, PSQ typecholesteatoma in5cases, mixed type (attic and PSQ) in 5 ears, and adhesive type cholesteatoma in 2 ears. The canal up technique was performed in 6 ears, and the canal down technique in 24 ears. Themastoid cavity was simultaneously obliterated using bone chips or hydroxyapatite granules in 20 ears. Atoperation, exposure of the facial nerve was observed in 13 ears, labyrinthine fistula in6ears, and thedura was exposed in5ears. An air-bone gap closure less than 20dB was achieved in 48% of the patients.No recurrence of cholesteatoma occurred during the subsequent 3-year observation period.
Based on these observations, cholesteatoma in the elderly generation can be considered as follows;bone destruction is more frequently observed the duration of the illness is increased but the condition of thecholesteatoma itself is mild and no severe inflammation is observed. Thus, the clinical course is favorablepostoperatively due to minimal recurrence of cholesteatoma. It is concluded that cholesteatoma in elderypeople can be treated safely and without difficulty by the surgeons well appraised of the patients condition.