Clinicopathological Study of the Chronic Otitis Media (Mastoidectomy for Cholesteatoma)

There have been many advances in the treatment of suppurative inflammation of the middle ear; however, the problem of chronic otitis media remains a significant part of the otologist's practice. There have been remarkable advances in antibiotic therapy. The otologist is still faced with the challenge of treating the affects of chronic inflammation of the middle ear and mastoid. This challenge is particularly difficult if the chronic ear problem is affected by the formation of cholesteatoma. If an ear develops a cholesteatoma that can not be completely exteriorized by office management, the treatment is surgical. It is the purpose of this paper to report the author's experience over 10 years of treating cholesteatoma using the radical mastoidectomy technique. Because the author realizes that long term results of surgery for cholesteatoma are important. From Jan. 1, 1973 to Dec. 30, 1982, 81 ears were treated by the author with radical mastoidectomy with tymapnoplasty, radical mastoidectomy without tympanoplasty and atticotomy for chronic otitis media accompanied with cholesteatoma. The result of this study as follow; 1) Sex distributions were male : famale ; 1:1.02. 2) Age distributions were 35(43.2%) in second decade, 30(37.0%) in first decade, 14(17.3%) in third decade in order. 3) Site distribution were 44(54.3%) in left, 37(45.7%) in right. 4) Character of otorrhea were 67(82.7%) cases in purulent states, 9(11.1%) cases in sero-mucinous states and 5(6.2%) cases in dry states. 5) Sites of drum perforation were 29(35.8%) cases in total defect, 22(27.2%) cases in central perforation, 10(12.3%) cases in attic perforation and 9(11.1%) cases in marginal perforation in order. 6) Condition of E-tube function were 40(49.4%) cases in poor states, 26(32.1%) cases in fair states and 6(7.4%) cases in good states. 7) X-ray findings of temporal bone were 68(83.9%) cases in sclerotic, 6(7.4%) cases in pneumatic and 2(2.5%) cases in diploic type. 8) Degree of preoperative hearing loss; 22(27.2%) cases were moderately severe degree, 17(21.0%) cases were severe and 21(25.9%) cases were not checked or missing of record. 9) Type of preoperative hearing loss were 39(48.1%) cases in conductive type. 14(17.3%) cases in mixed type and 5(6.2%) cases in sensorineural hearing loss. 10) Type of anesthesia were 61(75.3%) cases under the general anesthesia, 20(24.7%) cases under the local anesthesia. 11) Type of operation were 56(69.1%) cases in mastoidectomy without tympanoplasty, 11(13.6%) cases in mastoidectomy with tympanoplasty and 14(17.3%) cases in atticotomy technique. And operation hours were taken 38(46.9%) cases within 2 hours, 23(28.4%) cases within 3 hours and 4(4.9%) cases within 4 hours in order. 12) Route of approach were 66(81.5%) cases in endaural, 12(14.8%) cases in postauricular and 3(3.7%) cases in transmeatal approach. 13) Condition of middle ear mucosa were 59(72.9%) cases in diseased(It's means of edema, granulation and missing). 14(17.3) cases were squamous and 7(8.6%) cases were intact. 14) Condition of ossicles; missing were 58(71.6%) cases, fixed were 18(22.2%) cases and 5(6.2%) cases in intact. 15) Extent of cholesteatoma were 23(34.3%) cause in attic antrum, 20(29.9%) cases in attic antrum middle ear and 16(23.9%) cases in attic in order. 16) Incidence of destructed outer structure of mastoid antrum were 25.9% and surrounding structure of mastoid antrum were 32.1%. 17) Post-operative change of pure tone average were 15(60%) cases in no change, 6(24%) cases in improvement of 11-15 dB and 2(8%) cases in worse than-10dB, Postoperative audiometry rate is 30.9%.