Abstract Otology 2000 B15-1

Bernard Ars MD, PhD

Consultant University Hospital Researcher University Antwerp Temporal Bone Foundation B-Bruxelles

Tympanic membrane retraction pocket as well as cholesteatoma, are both expressions of chronic middle ear disease. In case of retraction pocket, we observe a dysfunction, and in case of cholesteatoma, a bad localisation of the stratified squamous epithelium which plays a crucial role in the development of this pathology. The author evokes analyses the moment and reason for the transformation of a tympanic membrane retraction pocket into cholesteatoma. In accordance with the literature, he explains the mechanism as follows : a local additional irritation process should trigger the keratinocytes of the bottom of the bony canal, and raise the control processes which put a brake on the epithelium of the bottom of the bony canal, during his unrestrained growth forwards, into the middle ear cleft, leading to cholesteatoma.

Abstract Otology 2000 B15-2

Ch. Milewski MD, Joachim Müller MD, S.Y. Park MD

Department of ENT/HNO Julius-Maximilians-Universität D-Würzburg

After complete removal of the cholesteatoma matrix, reconstruction of the tympanic membrane and the posterior canal wall may be needed, together with repair of the ossicular chain. Following Attico-Antrotomy (Wullstein) we reconstructed the eardrum or posterior canal wall by autologeous cartilage, using a composite graft of perichorium and cartilage from the tragus. The anatomical and functional results of 174 surgical procedures, 92 radical cavities and 82 reconstructions of the posterior wall will be presented. All operation were carried out by one surgeon (senior author), the mean postoperative survey was two years.

Abstract Otology 2000 B15-3

Levent Olgun MD, Erdem Cetinkaya MD, Erdal Gül MD, Gürol Gültekin MD, Sezaver Alper MD, Türkan Bakalim MD

SSK Izmir Educational HDSP TR-Izmir

In this study, late results of functional surgery done for attic cholesteatoma were presented. Thirty cases operated on between 1992 and 1993 were evaluated in 1998. Otomicroscopy and hearing results were recorded and compared with the preoperative data. The operation was wall down surgery in 18 cases and closed surgery in 12 cases. In 22 cases any kind of ossicular reconstruction were done. Tympanic membrane was intact in 29 out of 30 cases. In that 29 cases air conduction thresholds were 7-35 dB higher than preoperative levels. Otolog incus transposition, Wehrs incus-stapes prosthesis and incus replacement prosthesis gave the best results. Both open and closed techniques were found to be safe and reliable in attic cholesteatoma cases.

Abstract Otology 2000 B15-4

Kee Hyun Park MD, Ph.D.

Department of Otolaryngology Ajou University School of Medicine ROK-Suwon

The goal of the surgery for cholesteatoma in the middle ear is to provide the patient with a dry, safe ear and good hearing. An additional goal is not only to maintain a normal ear canal contour, that is, avoiding cavity problems, but also to minimize the need for long-term care of the operated ear. There are some attic cholesteatomas in which the middle ear is aerated and free of significant disease. So attic cholesteatoma surgery is thought to be reconstructive rather than destructive and it can be a prophylactic operation. In this study, I attempted to describe prerequisites for atticoplasty for attic cholesteatoma, which is one of the reconstructive surgical procedures for the middle ear. During the last 10 years, I managed surgically about 200 cases of attic cholesteatoma, among which there were 30 cases of atticoplasty, about 30 cases of mastoid obliteration, about 30 cases of intact canal wall mastoidectomy, and about 110 cases of open cavity mastoidectomy. I analysed 30 cases of atticoplasty with special reference to period of postoperative care and hearing results, as compared to cases with mastoid obliteration and open cavity mastoidectomy. I concluded that the prerequisites for atticoplasty during surgery for attic cholesteatoma were as follows; (1)no otorrhea at the time of operation; (2)intact posterior mesotympanum in the operation field; and (3) removal of incus and malleus head during the operation.

Abstract Otology 2000 B15-5

Masafumi Sakagami MD, PhD, Mieko Sone MD, Yasuo Mishiro MD

Dept. ORL Hyogo College of Medicine J-Hyogo

The purpose of this study is to assess clinical and surgical findings of acquired bilateral cholesteatoma with special reference to habitual sniffing. Twenty-eight cases of bilateral choleateatoma were treated at the department of Hyogo College of Medicine from 1995 to 1998, which were 12.7% of all operated cholesteatomas (n=221). They were 12 males and 16 females with mean age of 43.7 years old. They consisted of 33 ears of pars flaccida type, 17 ears of pars tensa type and 6 ears of unclassified postoperated ear. Preoperative hearing level was 46.3 dB in air conduction and 23.2 dB in bone conduction, while postoperative air conduction hearing level was 49.4 dB. Habitual sniffing was observed in 19 ears of pars flaccida type (57.6%), in 6 ears of pars tensa type (37.5%). 36 ears were operated on in our department. Surgical techniques were canal wall up in 8 ears, canal reconstruction and obliteration in 21 ears and canal wall down in 8 ears. Most of the ears treated with canal wall up showed retraction of the ear drum postoperatively. The concept that closing failure of the Eustachian tube and consequent inclination to sniff habitually are closely related to the pathogenesis of middle ear diseases was first introduced by Magnusson (1978) and later by Kobayashi et al. (1991). The present study suggested that canal wall down method was recommended in patients with bilateral cholesteatoma because they had high risk of retraction of the ear drum by habitual sniffing.