APPROPRIATE STANDARD FOR SURGERY OF PARS FLACCID CHOLESTEATOMA

• Published in: JIBI INKOKA TEMBO Vol. 48; no. 1; pp. 18 - 27
• Main Authors: Kojima, Hiromi, Shiwa, Masanori, Tanaka, Yasuhiro, Miyazaki, Hidemi, Moriyama, Hiroshi
• Format: Journal Article
• Language: Japanese
• Published: Society of Oto-rhino-laryngology Tokyo 2005; 耳鼻咽喉科展望会
• Subjects: pars flaccid cholesteatoma; recurrent rate; surgical standard; 再発率; 弛緩部型真珠腫; 後壁保存; 術式
• ISSN: 0386-9687; 1883-6429
• DOI: 10.11453/orltokyo1958.48.18

Our choice of surgery for acquired middle ear cholesteatoma is based on two fundamental principles : 1) the physiological morphology and function should be preserved to the maximum extent possible postoperatively, i.e., the posterior wall of the external auditory meatus and mucosa of the middle ear cavity should be well preserved; 2) the surgical procedure is selected based on the extent of invasion and the morbidity associated with the cholesteatoma, including the status of the remaining mucosa of the middle ear cavity. The subjects registered for this study, which was conducted to collect evidence to establish the standards for selection of the surgical procedure, were patients who had undergone initial surgery for cholesteatoma of the pars flaccid type at our department during the 15-year period from 1988 to 2003. The postoperative recurrent rate and improvement of hearing were analyzed in these. The standards for selection of the surgical procedure according to the morbid condition were established in 1996, based in particular, on the postoperative recurrent rate of cholesteatoma during the 8-year period from 1988 to 1995. The 15-year period from 1988 to 2003 was divided into the former half (8-year period) and the latter half (7-year period), with 1996 as the cutoff year. The recurrent rate (after one-stage conservative surgery for the posterior wall, i.e., canal wall-up) and improvement of hearing were compared between these two periods. The recurrent rate was distinctly lower following surgery during the latter period. The hearing was favorably improved for both periods. The results suggest improved surgical skills, decreased severity of inflammation, and the validity of the standards established in 1996 for selection of the surgical procedure.