(A) clinical evaluation of chronic otitis media with cholesteatoma
중이 진주종의 병인과 병태는 아직 확실하게 밝혀져 있지 않으나 주위 골조직의 파괴로 인한 위험한 합병증을 유발하는 빈도가 높고 치료를 위한 수술방법에 대한 학자들의 견해가 일치하지 않고 있으며 또한 수술후 재발율이 높아 문제점이 많은 질환이다.
이에 저자는 1975년 1월부터 1981년 12월까지 6년간 연세대학교 의과대학 부속병원 이비인후과에서 진주종성중이염으로 수술을 시행한 342예에 대하여 그 병태 및 수술방법에 따른 결과를 비교검토하여 차후 진주종성중이염의 수술적 치료에 도움을 얻고자 본 연구조사를 시행하였으며 그 결과 및 결론은 다음과 같다.
1. 진주종이 유양돌기까지 깊게 침범된 예는 성인보다 소아에서 많았다.
2. 고막천공은 전천공이 50%, 상고실천공이 27.8%였으며 중앙천공도 14.6%있었다.
3. 수술당시 이미 가지고 있던 합병증은 안면신경마비와 이후부누공이 각각 1.5%로 가장 많았고, 미로누공과 뇌막염이 각각 0.6%였다.
4. 수술전 청력은 전음성난청이 63.5%였고 혼합성난청이 27.1%였으며 농(deaf)도 7% 있었다.
5. 총 342예중 수술후 계속적인 이루는 12.9%, 고막이식실패는 12.4%에서 나타났으며, 개방형술식에서늘 계속적인 이루(23.8%)가, 밀폐형술식에서는 고막이식 실패(16.9%)가 수술실패의 주된 소견이었다.
6. 수술후 합병증은 창상감염이 6.7%로 가장 많았으며 밀폐형술식에서 12.1%로 특히 많았다. 또한 술후농(post-op. deaf)이 4예(1.2%)있었는데 이는 미로누공과 등골절제술에 의한 것이었다.
7. 술후 청력이 개선된 예는 45.6%였고, 밀폐형술식이나 개방형술식 간에 차이는 없었다.
8. 재수술을 실시한 67예중 계획된 단계수술과 청력개선을 위한 수술을 제외하면 40예에서 수술합병증으로 인한 재수술이 필요하였으며 그 원인으로는 잔여진주종이 19예, 재발성진주종이 8예였다.
9. 밀폐형술식을 시행한 예중 79.8%에서 단계수술을 계획하였으며 이중 79.8%에서 이차수술을 실시하였고 수술간의 간격은 평균 9.8개월이었다.
10. 이소골재건술후 청력개선은 추골병과 등골의 상부구조가 정상인 경우가 가장 좋았고 특히 추골병의 유무가 청력개선에 중요한 영향을 미친다고 사료되었다.
The etiology and pathophysiology of chronic otitis media with cholesteatoma are not clearly understood, but it is known that the disease can be treated by means of complete removal of cholesteatoma and involuted lesions. The difficulty of this
surgical method, however, lies in improving hearing with preservation of normal structure of the ear as much as possible. To solve this difficulty, several studies have been done and new technics have been developed. However, because of different
opinions on the operation technics among the researchers and high incidance of post operative recurrence, there still remain several problems.
Clinical analysis, especially on the post-operative complication and port-operative improvement of hearing, has been made according to the extension of disease and to the methods of operation.
The materials were composed of 342 ears which had chronic otitis media with cholesteatoma and were operated at Department of Otolaryngology, Yonsei University College of Medicine from Jan, 1975 through Dec, 1981.
The results obtained were as follows:
1. There are 28 cases of children under 15 years old and 314 cases of adults over 16 years old. Out of these cases, 22cases(77.8%) of children had cholesteatoma extended to mastoid process and 189 cases(60.2%) in adults.
2. As a condition of ear drum, 171 cases(50.0%) had total perforation, 95 cases(27.8%) had attic perforation and 50 cases(14.6%) showed central perforation.
3. As a complication, 5 cases(1.5%) had facial paralysis, 5 cases(1.5%) had retroauricular fistula, 2 cases(0.6%) had labyrinthin fistula and 2 cases(0.6%) had menigitis.
4. Pre-operative hearing with pure tone audiogram were, 217 cases(63.5%) had conductive hearing loss, 93 cases(27.1%) had mixed hearing loss and 24 cases(7.0%) had deafness.
5. Post-operative failure rate at 3 months were, 44 cases(12.9%) had draining ear and 33 cases(12.4%) had drum uptake failure. Main result of failure was draining ear(23.8%) among open technic group and drum uptake failure(16.9%) among closed technic group.
6. As post-operative complication, wound infection was found in 23 cases(6.7%), mainly among closed technic group with 15 cases(12.1%). 4 cases(1.2%) had post-operative deaf.
7. Out of 57 cases, that underwent post-operative audiogram, 26 cases(45.6%) were found to have hearing improvement. There was no difference of hearing improvement between open technic and closed technic.
8. As causes of revision, out of 67 cases, that underwent revision, 26 cases were planned second staged operatics, 19 cases had residual cholesteatoma and 8 cases had recurrent cholesteatoma.
9. Out of 124 cases, that underwent closed cavity mastoidectomy with tympanoplasty, 99 cases(79.8%) were planned for staging the operation and among them, only 29 cases(29.3%) had second staged operation. The mean duration between first and second operation was 9.8 months.
10. In staged operatic, the condition of ossicle and hearing impairment are related in such a way that it is considerably improved in presence of malleus handle and arch of stapes. From this study, I was able to find out that hearing improvement is influence by the presence of malleus handle.