小児真珠腫性中耳炎手術成績
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概要
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Clinical characteristics of middle ear cholesteatoma in children and its surgical results were analyzed and discussed. From 1978 to 1986, 22 children under 10 years old were operated on in our clinic. The findings obtained were as follows: 1. The cases consisted of 15 ears having attic type cholesteatoma and 7 having adhesive type cholesteatoma which developed from the posterior superior quadrant of the adhesive ear drum. 2. Bacteriological examinations were positive in 16 ears and negative in 6 ears. Of the ears bacteria positive, gram negative bacteria were found in 8 cases. 3. Hearing loss was more severe in the adhesive type cholesteatoma because of the greater destruction of the ossicular chain, especially the stapes. 4. In the contralateral ear, otitis media exsudativa was found in 4 of 15 cases of attic type cholesteatoma, and 5 of 7 adhesive type. 5. In 10 cases the closed surgical procedures were used, the canal wall reconstruction method in 5 cases, and the open method in 7 cases. 6. Of the 10 cases operated on using the closed method, 4 cases were reoperated; 3 of them using the closed method, the other using the open method. Of the 5 cases operated on using the reconstruction method, 3 cases were reoperated; 1 using the closed method, 2 using the open method. Of the 7 cases operated on using the open method, 3 cases were reoperated. In 2 cases out of the 10 opened cases, a third operation was necessary because of recurrece. 7. Finally, 12 cases have maintatined a normal external ear canal shape and 10 cases have lost their posterior canal wall. 8. There were no differences in the recurrence rates between the surgical methods and the types of cholesteatoma, although the surgical method was decided without distinction of clinical findings. In conclusion, it would be possible to say that cholesteatoma in children could be operated on using the closed method at primary operation.
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