결론

ⅤⅤ. . . . 결론결론결론결론

초기 중이 진주종의 치료를 위한 수술법으로서의 atticosinoplasty는 청력개선 에 효과가 있었으며 합병증은 미미하였다. 향후 초기 중이 진주종의 수술적 처치 에 일관된 개념이 도입이 향후 진주종성 중이염의 치료에 있어 비약적인 발전을 이끌어 낼 수 있을 것으로 기대되며, 본 연구의 결과는 초기 중이 진주종의 치료 에 있어서 atticosinoplasty의 유용성을 보여주고 있다. 이는 초기 중이 진주종 의 치료의 효율적이고 체계적인 접근이나 선택에 있어서 atticosinoplasty가 의 미있는 방법임을 보여준다.

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- - -

- ABSTRACT ABSTRACT ABSTRACT -ABSTRACT --

^{Treatment Treatment Treatment} Treatment of of of of early early early middle early middle middle ear middle ear ear cholesteatoma ear cholesteatoma cholesteatoma cholesteatoma by by by

by atticosinoplastyatticosinoplastyatticosinoplastyatticosinoplasty

Seung Ku Park

Department of Medical Sciences The Graduate School, Ajou University

(Supervised by Professor Keehyun Park)

BACKGROUND AND OBJECTIVES : Treatment of early cholesteatoma usually involves surgical modification of mastoid antrum and tympanum to prevent recurrence. Reconstruction of ossicular chain and the ear drum after complete elimination of cholesteatoma in tympanum improves hearing greatly. However, like in other fields of clinical medicine, treatment of early cholesteatoma is advancing through trial and errors, and many new surgical techniques are still being published until this time. Despite of continuing achievement and effort, there have been considerable controversies upon systematic approach and treatment method in middle ear surgery. These difficulties, however, will be overcome and development of such treatment methods will eventually increase operation of early cholesteatoma and revisional ear surgery.

With its increasing importance, it will be meaningful to evaluate the role of atticosinoplasty in the treatment of early cholesteatoma, and to

compare its effect in improving hearing with other techniques like mastoid obliteration and open cavity mastoidectomy.

METHODS : Retrospective review was performed for 173 cases treated by atticosinoplasty in the period of 12 years between Mar 1995 and Feb 2007 in Department of Otolaryngology of Ajou University Medical Center. Of 156 cases with more than 6 months of follow up period, 120 cases of relatively small cholesteatoma on temporal bone tomography were comparatively analysed for hearing improvement with 35 cases of mastoid obliteration and 110 cases of open cavity mastoidectomy. We analysed results according to the type of cholesteatoma and ossiculoplastic materials. We also compared 40 cases with near-normal hearing before surgery in terms of types of cholesteatoma and ossiculoplastic materials.

RESULT : When 120 cases of atticosinoplasty for early cholesteatoma were compared for hearing improvement with 35 cases of mastoid obliteration and 110 cases of open cavity mastoidectomy, patients treated by atticosinoplasty had significantly better results. In analysis by type of cholesteatoma, attic cholesteatoma had relatively better results.

Comparison among ossiculoplastic materials showed malleus stapes strut gave relatively good results. In the cases of near-normal hearing group, better maintenance of hearing acuity was shown when ossiculoplasty was not performed. Analysis according to type of cholesteatoma showed better results in attic cholesteatoma. There were good results regardless of ossiculoplastic material used.

CONCLUSION : Atticosinoplasty as an initial treatment choice for early cholesteatoma was certainly effective in improving hearing acuity with minimal complications. In the future, when a universal concept is introduced to surgical treatment of early cholesteatoma, atticosinoplasty will be a useful option in the systematic approach.

key key key key wordswordswords : atticosinoplasty, cholesteatoma, open cavity mastoidectomy, words mastoid obliteration, ossiculoplasty