Three-dimensional images by helical computed tomography are useful to understand anatomy and pathology of the temporal bone. But it was not enough to observe a minute findings for example the crus of stapes and the facial nerve. The Multidetector-row CT (multislice helical CT), compared to the conventional system, simultaneous acquisition of data with 4 rows of detectors, and high -speed processing to handle 4 to 10 times the volume of data. Multislice helical scanning with 4 rows of 0.5mm slice enabled us to acquire isotropic volumetric data, resulting improvement in image quality of multiplanar reconstruction images. Application of the multislice helical CT has made it possible to reconstruct 3-D images of the minute and complicated structure of the temporal bone. We could find the minute findings of the middle ear, incudostapedial articulation, the crus of stapes and the facial nerve and others with3-dimensional reconstruction images by the multislice helical CT and it was possible to find the change of the middle ear with cholesteatoma. It was found that 3-dimensional images by the multislice helical CT was very useful in observing the minute structure of the middle ear in that it could ascertain spatial relationships and pathology.
Between January 1997 and December 2001, 27 ears with recurrent cholesteatoma, 13 ears with suppurative otitis media, and 5 ears with hearing impairment were reoperated in Mie University Hospital. Canal wall down tympanoplasty with canal reconstruction was performed in 26 ears with recurrent cholesteatoma, and 1 ear was operated by canal wall down tympanoplasty. Postoperative attic retraction was found in 3 of 4 ears (75.0%) with cortical bone reconstruction, and 3 of 23 ears (13. 0%) with auricular cartilage reconstruction, indicating that auricular cartilage is useful to prevent attic retraction and retraction cholesteatoma. Success rates of hearing improvement, according to the criteria of Otology Japan (2000), were 100% of type I tympanoplasty, 75.0% of type III, and 75.0% of type IV. Reoperation of 13 ears with suppurative otitis media was successful in stopping otorrhea. Success rates of hearing improvement were 50% of type I tympanoplasty, 75.0% of type III, and 33.3% of type IV. Reoperation of all 5 ears with hearing impairment was successful in restoration of hearing.
We examined the clinical findings of aquired unilateral cholesteatoma with special reference to habitual sniffing. One hundred and two fresh cases of unilateral cholesteatoma, which were operated on at Department of Otolaryngology, Hyogo College of Medicine, were examined in this study. Responses to detailed questionnaire were obtained from patients concerning about a habit of sniffing to relive the symptoms such as aural fullness, autophonia or hyperacusis. We also examined the contralateral ear under the microscope. Habitual sniffing was found 38 ears (37.3%) and we devided the patients into two groups (habitual sniffing group and non-habitual sniffing group). Normal ear drum was 44.7%, pocket formation was 39.5%, adhesion of the ear drum was 7.9%, retraction of the ear drum was 5.3% and secretory otitis media was 2.6% in the habitual sniffing group. In contrast, normal ear drum was 90.8%, pocket formation was 3.1%, adhesion was 3.1% and chronic otitis media was 9.3% in the non-habitual sniffing group. The abnomarity of the contralateral ear was statistically much higher in the habitual sniffing group than in the non-habitual sniffing group (p<0.001).
Two cases of large vestibular acqueduct syndrome (LVAS) are presented. The first case was a 13-year-old boy, who had been observed 9 years. At the initial examination, hearing threshold was 80dB in the left ear and 60dB in the right ear. He experienced acute hearing deterioration four times, at each time hearing showed recovery by oral administration of steroids, vitamin B12. He was found to have a mutation in the chromosome 7q31. The second case was a 21-year-old women and she had been observed for 14 years. Initially a pure-tone audiogram showed 65dB hearing loss bilaterally. She had experienced acute hearing deterioration accompanied or unaccompanied by vestibular disturbance 11 times. Steroid hormone and vitamin B12 given at each episode were effective. Hearing thresholds at the last pure tone audiogram were 70dB of the left, and 80dB on the right. These findings suggested that hearing deterioration the LVAS could be managed for long term by conservative treatment.
The surgical treatment for congenital atresia of the external ear canal has a problematic aspect because of the dificulty of the surgery itself, for example, operative insult such as the facial nerve injury and postoperative problem such as re-stenosis and post-operative middle ear infection. We invented a new approach for this disease, and called it as the modified transmastoid approach. In this preliminary report we showed our two cases which were followed up for 1 year. Our approach is available for not only avoiding the facial nerve injury in surgery but also for not occuring the post-operative middle ear infection and re-stenosis of the new external ear canal. The post-operative hearing acuities were also satisfactory.
There are several procedures available for stapes surgery, including small-fenestra stapedotomy (SFS), traditional stapedectomy, and stapes mobilization. SFS is generally regarded as the procedure of first choice, in terms of the improvement of hearing level after the surgery. However, SFS is a difficult surgical procedure to Japanese, making it sometimes necessary to revert to traditional stapedectomy. Moreover, otoscierotic changes of the footplate are relatively mild in many Japanese patients, making laser techniques a viable alternative. Laser techniques allow us to perform the easy and safe stapedectomy, because cutting of the crura and fenestration of the footplate is performed without making physical contact with these structures. We found that using a Rosen suction tube to hold the quartz fiber of a KTP laser provided a sufficient field of view to allow delicate surgery to be performed. Postoperative results demonstrated the disappearance of the original A-B gap in the pure-tone audiogram. However, a temporary vertiginous feeling occurred, which may have been caused by the laser treatment slightly impairing the inner ear function.