연골을 이용한 방패형 제3형 고실성형술의 임상적 유용성

Background and Objectives: Many types of cartilage tympanoplasty have been used in various middle conditions effectively. The purpose of this study is to evaluate the efficacy of type III cartilage shield tympanoplasty. Subjects and Methods: We adopted a carvum conchal cartilage shield tympanoplasty for 3 cases of cholesteatoma, 6 adhesive otitis media, and 6 chronic otitis media of near-total perforation. Malleus handle was medialized but intact before surgery in all the 15 cases. For the hearing outcome evaluation, we set control group of conventional type III tympanoplasty with cartilage capping partial ossicular reconstruction using partial ossicular reconstruction prosthesis. Air-bone gap (ABG) was compared between the study group and control group before and after surgery, and postoperative neo-drum status and complication was evaluated. Results: None of the study ears showed reperforation or any complication at minimum 9 months of follow-up. Two cases were found to have anterosuperior partial retraction of neo-drum. The average ABG was 27.2±9.4 dB preoperatively and 19.0±11.6 dB postoperatively in study group, and 39.58 ± 18.92 dB preoperatively, 20.76±21.36 dB postoperatively in control group. No statistical difference of ABG was found between study and control group (p>0.05). Conclusions: Cartilage shield type III tympanoplasty was safe and effective in high risk of failure group such as large perforation, atelectasis, adhesive otitis media, and cholesteatoma with medialized malleus. (J Clinical Otolaryngol 2013; 24:50–55)