鼓室成形術の遠隔成績 : 岡山大学耳鼻科教室における10年間(昭和38-47年)の手術例の観察

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Tympanoplasties were done on 956 ears (789 persons) in Okayama University for the past 10 years. The results of a long term follow-up were obtained recently in 351 ears (284 persons) of them. In 351 ears, the primary operations were done in 67%, and W-I type∗ and W-II type (these two types are called as “conservative type group”, and the other types are called as “radical type group”) were done in 50%. (∗W-I type means the Wullsteins classification type I.) RESULT 1) The rate of no perforation in tympanic membrane after surgery; The rates in the primary operation and in the revised operation, and in each type of operations were between 84% and 72%. The rates in double grafting, temporal fascia graft, meatal skin flap were between 92% and 67%, but it was less than 73% in thigh skin graft. 2) The results of hearing gain; The average hearing loss of air-conduction in speech range was used for the judgement of hearing gain after surgery. It was regarded as success that (1) the average hearing loss was better than 30 dB, or (2) the hearing gain after surgery was more than 11dB. (A) The rate of success in the conservative type group was 62% in the primary operation, and was 73% in the revision. The rate of success in the radical type group was about 30% in the primary operation and also in the revision. (B) The rates of success in the conservative type group of the primary operation were from 67% to 61% in the double grafting, temporal fascia graft and meatal skin flap, but it was 46% in thigh skin graft. The rate of success of the revision was 90% in double grafting, 86% in temporal fascia graft, 67% in thigh skin graft and 57% in meatal skin flap. The rate of success in the radical type group of the primary operation was 36% in meatal skin flap, 30% in temporal fascia graft, 23% in double grafting and 8 % in thigh skin graft. The rate of success of the revision was 67% in double grafting, 58% in temporal fascia graft, 26% in meatal skin flap and 13% in thigh skin graft. (C) The rate of success was 37% in the modified W-III type and 23% in modified W-IV type. The rates of success of the modified types in which columella with tragal cartilage and transposition of ossicles was used, were from 42% to 27%, but it was less than 11% in polyethylene tube. 3) There was almost no difference in recurrence rate of middle ear inflammation between the open method and the closed method. On the basis of these results, the operation technique was described that was considered to be the most preferable at present in our clinic.
社団法人日本耳鼻咽喉科学会の論文

鼓室成形術の遠隔成績 : 岡山大学耳鼻科教室における10年間(昭和38-47年)の手術例の観察

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