상고실성형술과 유양동폐쇄술의 세가지방법에 따른 95예의 비교 분석 결과

Background and Objectives: We reported an epitympanoplasty with mastoid obliteration, a combined method using the advantages of canal up and down techniques in cholesteatoma surgery. This procedure was originally designed to prevent recurrence of the cholesteatoma by obliterating the mastoid cavity and reconstructing the epitympanum. We could improve the surgical results by modification of the surgical techniques. Materials and Methods: From December 1994 to April 1999, we have operated 95 adult cases. Cholesteatoma, adhesive otitis media, and chronic otitis media were 78, 9 and 8 cases respectively. Six cases of them had previous surgery. The methods were classified into 3 different sub method groups according to the material of reconstruction of the epitympanum and obliteration of the mastoid cavity. Results: All cases had no recurrent cholesteatoma. Three cases of residual cholesteatoma in the mastoid cavity were detected only for group I. Three cases of residual cholesteatoma in the tympanic cavity for group I, and one case for group II were detected. Three cases of postoperative infections for group I, and one case for group II and III were identified separately. Conclusion: During follow-up period, unpredictable patterns of resorption of bone paste for the epitympanoplasty were observed for group I. Resorption was not observed with using cartilage chips for the other two groups. In addition, using cartilage chips for the group II and III, postoperative infection was much decreased comparing to goup I with bone paste. Mastoid obliteration with cartilage chips seemed to make it easy to approach to the mastoid antrum in revision. For the group II and III, the mastoid cavity was completely separated from the tympanic cavity by placing the fascia or perichondrium at the aditus and antrum in order to prevent the residual cholesteatoma from extending into the mastoid cavity. (J Clinical Otolaryngol 2000;11:273-279)