KISEP Otology Korean J Otolaryngol 2005;48:713-7 진주종성중이염을동반한소아에서상고실성형술과유양동폐쇄술의결과분석 강명구 박동은 박병건 배우용 이태훈 Epitympanoplasty with Mastoid Obliteration Technique in Children with Cholesteatoma Myung-Koo Kang, MD, Dong-Eun Park, MD, Byung-Gun Park, MD, Woo-Yong Bae, MD and Tae Hoon Lee, MD Department of Otolaryngology-Head & Neck Surgery, College of Medicine, Dong-A University, Busan, Korea ABSTRACT Background and Objectives:Cholesteatoma in children has a more aggressive growth pattern than observedin adults and often involves the entire mastoid and tympanic cavity, which necessitates early surgical treatment. The rapid tissue growth, the greater degree of infection and inflammation brought on by the Eustachian tube, and well pneumatized mastoid are the major contributing factors for being so extensive in children. In this study, we evaluated the result of epitympanoplasty and mastoid obliteration in of children. Subjects and Method:The operation was performed in 28 children patients under the age of 15 from May 11, 1995 to August 13, 2003. They were 3 congenital and 25 acquired cases, which were accompanied by 4 cases of adhesive otitis media, 1 case of external auditory canal, and 1 case of congential aural atresia that developed after two operations of canaloplasty. Results:Of the 28 cases, 6 underwent one-staged operation and 8 underwent second-look operations, respectively. In 3 of the 8 cases that underwent second look operation, there was residual in the tympanic cavity, and was removed. After operation, there was no recurrent. Among the 13 cases of ossiculoplasty, 9 could have the test of pure tone audiogram, and 5 cases could preserve postoperative air-bone gap within 30 db. Conclusion:It is expected that epitympanoplasty with the mastoid obliteration technique reduces the air-burden of E-tube in children of, and the technique probably can prevent the formation of retraction pocket and recurrence of. (Korean J Otolaryngol 2005;48:713-7) KEY WORDS:Epitympanoplasty Mastoid obliteration Child Cholesteatoma. - 713
소아에서 상고실성형술과 유양동폐쇄술 적용하여 병변의 재발과 진행을 막을 수 있었기에 문헌고찰 1, 2, 3 khz에서 청력역치의 골도기도간 차이를 평균하여 과 함께 보고 하는 바이다. 청력 개선여부를 확인하였다(AAO-HNS, 1995). 대상 및 방법 결 과 1995년 5월부터 2003년 8월까지 본원에서 진주종성 수술 후 28명 모두 진주종이었고 그 중 3명은 선천성 진 중이염으로 진단된 15세 이하의 소아환자 28명을 대상으 주종이었고 25명은 후천성 진주종이었다. 후천성 진주종 중 로 상고실성형술과 유양동폐쇄술을 시행하였다. 이들은 모 4명은 유착성 중이염이 동반된 경우였고 1명은 외이도 진 두 진단 당시 유양동은 경화형(sclerotic type) 혹은 판장 주종이 동반된 경우였으며 1명은 선천성 이기형으로 다른 상형(diploic type)이었고 진주종이 고실 혹은 유양동까지 병원에서 2차례의 외이도성형술을 시행 후 생긴 진주종이었 침범된 경우였다. 함기형(pneumatic type)의 유양동이면 다. 6명은 상고실성형술과 유양동폐쇄술과 함께 이소골 성 서 진주종이 고실내에 국한되고 이관기능이 좋은 경우는 형술을 동시에 하는 단일단계 수술(one-stage operation) 제외시켰다. 최소연령은 5세였고 평균관찰기간은 68개월 을 시행하였다. 8명은 일단계 수술(first stage operation) (최대 103개월, 최소 3개월)이었다. 술전 검사로는 고막 후 진주종의 잔존 및 재발 여부의 확인 및 이소골 성형술을 소견을 포함한 이학적 검사, 순음청력검사, 측두골단층촬 위한 second-look operation을 시행하였다(Table 1). Se- 영을 시행하였다. cond-look operation을 시행한 8명 중 7명은 이소골 성형 수술은 상고실절제술과 유양동절제술을 통해 상고실과 술을 시행하였으며 1명은 일단계 수술 당시 sinus tympani, 유양동 영역의 병변을 제거하고, 술 후 상고실 영역의 병변 등골 주위, 이관주위, 유양동에 진주종이 있었던 경우로 을 제거한 부분에 cartilage chip을 이용해 상고실성형술을 second look operation시 전체 고실, 고실개(tegmen tym- 시행하였고 유양동 영역의 병변을 제거한 부분에 bone pani)에 걸친 진주종이 발견되어 tympanization만 시행후 chip과 cartilage chip을 이용해 유양동폐쇄술을 시행하였 경과 관찰 중이다. 이 경우를 포함하여 3명은 잔류성 진주 으며, 외이도 후벽은 보존하였다. 수술 직 후 두개내 합병증, 종이 있어 모두 제거하였으며 잔류성 진주종이 있었던 다른 안면신경마비, 청력상태를 확인하였고 이후 고막소견 및 2명은 일단계 수술당시 sinus tympani, 고실 주위, 안면신 술 후 6개월째 측두골 전산화 단층촬영을 시행하여 재발 경와(facial recess)에 진주종이 있어 진주종을 완전 제거 여부를 확인하였다(Fig. 1). 순음청력검사를 시행하여 0.5, 하지 못하였던 경우들이다. Second-look operation 시행 A C 714 B D Fig. 1. Images of case 18. Preoperative axial (A) and coronal CT scans (B) of temporal bone show that mastoid and tympanic cavity are filled with soft tissue density. Post operative axial (C) and coronal CT scans (D) show that mastoid cavity are obliterated with cartilage and bone chips (thick arrow), that epitympanum with cartilage (thin arrow). Korean J Otolaryngol 2005;48:713-7
강명구외 Table 1. Patient details of cases of ossiculoplasty Patient Sex/ age Cause of disease Tympanoplasty Preop ABG Pure tone average Db Postop ABG ABG closure F/U month One stage 01 M/5 Cholesteatoma PORP 20 18.75 01.25 55 operation 02 F/10 Cholesteatoma TORP 55 27.75 27.25 33 03 M/10 Cholesteatoma, EAC T3 * 30 04 F/12 Adhesive otitis media, T1 F/U loss 05 M/5 Cholesteatoma short col. * 33 06 F/8 Congenital aural atresia T2 F/U loss s/p canaloplasty 2nd look 07 M/7 Cholesteatoma short col. 32.5 18.75 13.75 26 operation 08 M/5 Cholesteatoma PORP 20 17.5 02.5 60 1st stage operation tympanization only 09 M/7 Cholesteatoma TORP 36.25 32.5 03.75 81 10 M/8 Adhesive otitis media TORP 51.25 46.25 05 56 11 M/12 Cholesteatoma PORP 28.75 15 13.75 29 12 F/9 Cholesteatoma PORP 52.5 46.25 06.25 53 13 M/5 Cholesteatoma TORP 48.75 36.25 12.5 103 14 M/5 Cholesteatoma 59 15 M/14 Cholesteatoma 16 16 F/7 Congenital 12 17 M/11 Cholesteatoma 9 18 F/6 Cholesteatoma 3 19 M/4 Cholesteatoma 8 20 M/14 Adhesive otitis media 6 21 F/5 Cholesteatoma 25 22 M/8 Cholesteatoma 33 23 M/9 Cholesteatoma 43 24 F/8 Cholesteatoma 9 25 M/8 Cholesteatoma 26 26 F/12 Adhesive otitis media 7 27 F/9 Congenital 10 28 F/5 Congenital 33 T1tympanoplasty type 1, T2tympanoplasty type 2, T3tympanoplasty type 3. short col.short columerallization, PORPpartial ossicular replacement prosthesis, TORPtotal ossicular replacement prosthesis, Preop ABGpreoperative air-bone gap, postop ABGpostoperative air-bone gap, ABG closurepreop ABG-postop ABG. could not check because of Down syndrome with mental retardation, tympanization Table 2. postoperative changes of air-bone gaps in the ossicular reconstruction cases Postop ABG No. of patients 10 0 20 4 30 1 30 4 Total 9 Postop ABGpostoperative air-bone gap 715
소아에서상고실성형술과유양동폐쇄술 Table 3. Postoperative changes of air-bone gaps closure in the ossicular reconstruction cases Case N Preop ABG Postop ABG ABG closure 9 36.9413.39 30.2713.78 8.878.5 Values are meansddbhl. preoperative air-bone gap, postop ABGpostoperative air-bone gap, ABG closurepreop ABG-postop ABG REFERENCES 1) Glasscock E, Dickins E, Wiet R. Cholesteatoma in children, Laryngoscope 1981;91:1743-53. 2) Contencin P, Bassereau G, Chabardes E, Manac h Y, Narcy P. Cholesteatoma in children. Adv Otorhinolaryngol 1988;40:131-7. 3) Tos M, Lay T. Treatment of in children. Adv Otorhinolaryngol 1988;40:142-8. 4) Kang MK, Hong SH, Kim BM, Kim DH, Kim LS. Epitympanoplasty with mastoid obliteration technique in children. In: Magnan J, Chays A, editors. Proceedings of the Sixth International Conference on Cholesteatoma and Ear surgery. Cannes;2000. p.685-9. 5) Kang MK, Hur J, Kim LS. Epitympanoplasty with mastoid obliteration technique in only/better hearing ears. In: Magnan J, Chays A, editors. Proceedings of the Sixth International Conference on Cholesteatoma and Ear surgery. Cannes;2000. p.757-61. 716 Korean J Otolaryngol 2005;48:713-7
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