幼児の先天性中耳真珠腫に対する経外耳道鼓膜切除による摘出術

概要

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Postoperative topical ear treatment in infants is often difficult and troublesome. We removed congenital middle-ear cholesteatoma via partial transcanal myringectomy in 3 infants. Subjects were 2 boys and a girl aged 2–3 years. Two also had bilateral secretory otitis media. Cholesteatoma was closed type and was confined to the mesotympanum in all cases—the anterosuperior quadrant in 2 and the anterosuperior-anteroinferior quadrants in one. Operative procedure was as follows: the tympanic membrane was partially resected in proportion to cholesteatoma size without elevating ear canal skin. Cholesteatoma was removed through the perforation created, followed by immediate underlay myringoplasty using a temporal fascia graft. To eliminate postoperative topical treatment, no packing was placed in the ear canal. The fascia graft epithelialized satisfactorily in the three cases. The postoperative clinical course of two subjects has been uneventful in 10 to 13 months of follow-up. The third infant developed recurrent cholesteatoma and underwent a second operation 15 months after the first surgery. No re-recurrence has been seen in the 14 months since reoperation. Our approach involves minimal surgical invasion, requires no postoperative topical treatment, and is thus useful in removing congenital cholesteatoma confined to the mesotympanum, particularly in infants.