弛緩部型真珠腫と緊張部型真珠腫 (第2報)

• Published in: Otology Japan Vol. 24; no. 3; pp. 181 - 187
• Main Authors: 森田 由香, 山本 裕, 大島 伸介, 高橋 邦行, 根本 美歌, 桑原 優子, 高橋 姿
• Format: Journal Article
• Language: Japanese
• Published: Japan Otological Society 2014; 一般社団法人 日本耳科学会
• Subjects: hearing improvement; recurrence; stapes; tympanoplasty; アブミ骨; 再発; 聴力改善; 鼓室形成術
• ISSN: 0917-2025; 1884-1457
• DOI: 10.11289/otoljpn.24.181

Patients with pars flaccida cholesteatoma and pars tensa cholesteatoma who underwent initial surgery in our institute were classified based on the Classification and Staging of Cholesteatoma proposed by the Japan Otological Society in 2010. And we investigated the choice of surgical treatment and its outcome.Between 1999 and 2009, 238 cases of pars flaccida and 60 cases of pars tensa cholesteatoma were underwent surgery in Niigata University. Average age at the surgery was 43.5 years in flaccida type and 50 years in tensa type respectively.Regarding the surgical procedure, canal wall down tympanoplasty with mastoid obliteration was selected in 70% cases both pars flaccida type and pars tensa type. Considering the stage, trans canal atticotomy and canal wall up tympanoplasy were selected more frequently in the case of Stage I. And open method was adopted for 30% cases of Stage III in pars flaccida type.Hearing improvement in all subjects with pars flaccida cholesteatoma was 77.0% and that with pars tensa 44.2%. By the stage, success rate in the stage I was 84.6%, stage II 78.6% and stage III 60.9% in the pars flaccida cases. In pars tensa cholesteatoma, 85.7%, 41.4% and 31.3% respectively. In the pars flaccida cases, the tendency of deterioration of hearing result according to the extent of cholesteatoma was observed. But some cases of pars tensa cholesteatoma could not be obtained hearing improvement regardless the stage, the affected area and the status of stapes. The rate of recurrence was 6.2% in pars flassida and in 5.8% in pars tensa. As a conclusion, the control of cholesteatoma in the reported sases was satisfactory, but challenges remained to improve hearing. 1999年1月から2009年12月までの11年間に当科で初回手術を施行した弛緩部型真珠腫は238耳、緊張部型真珠腫は60耳であった。術式選択について、弛緩部型、緊張部型ともに外耳道後壁削除型鼓室形成術・乳突腔充填術が最も多く、いずれも約70%を占めていた。またStage別では、Stage Iでは、経外耳道的上鼓室開放術や外耳道後壁保存型鼓室形成術の割合が多く、一方弛緩部型のStage IIIでは、約30%でopen法を選択していた。術後12か月の聴力成績は、弛緩部型が77%に対し、緊張部型は44%と著しく不良であった。聴力成績別に検討すると、弛緩部型は真珠腫の進展範囲が高度であるほど聴力成績が悪化する傾向がみられた。一方、緊張部型では、進展度に関係なく、聴力成績不良例が多く、緊張部型真珠腫の病態そのものが影響している可能性が示唆された。再発率は弛緩部型6.2%、緊張部型5.8%と良好であった。