Endoscopic Approach to Tympanic Sinus during Tympanomastoidectomy for Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Whether through a posterior tympanotomy or after canal wall-down mastoidectomy, visuali-zation of the most posterior recess of the tympanic sinus is often inadequate. The purpose of this study is to assess the usefulness of endoscopic approach to tympanic sinus during chlolesteatoma surgery. MATERIALS AND METHODS: Twenty six cases that had been operated by a same surgeon were reviewed. The mean follow-up period was 12.5 months. Four cases with cholesteatoma confined to tympanic sinus had underwent tympanoplasty. Twenty-two cases had underwent canal wall-down mastoidectomy with or without ossiculoplasty. RESULTS: Two patients (7.7%) showed recurrence of cholesteatoma in tympanic sinus within 6 postoperative months. Twenty-four cases showed normal state. CT scans were performed in 14 cases before the second look operation. All free air cavities on the CT scan showed no residual cholesteatoma. CONCLUSION: The endoscopic approach to the middle ear in association with a microscope enables surgeons to eradicate the cholesteatoma at the tympanic sinus more effectively.

Clinical Study of Laser Myringotomy with Ventilation Tube Insertion on Pediatric Chronic Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Complications of a knife myringotomy with ventilation tube insertion is rather frequently encountered. To reduce such complications, we have performed myringotomy using a contact Nd: YAG laser. The purpose of this study was to evaluate the efficacy and safety of laser assisted myringotomy (LAM). MATERIALS AND METHODS: Sixty three patients (106 ears) of ages 1 to 7 were investigated retrospectively. Under the intravenous general anesthesia, LAM was performed to create a 2.0 mm sized perforation. After LAM, a ventilation tube was inserted. RESULTS: All ears underwent successful placement of ventilation tubes. Compared with knife myringotomies, LAM was safe to use in the atrophic tympanic membrane. There were also less intraoperative bleeding and tube plugging, with much lower postoperative otorrhea and myringosclerosis compared to knife myringotomies. Granuloma around the tube did not occurred. Postoperative improvement of air-bone gap reflects that LAM does not damage the inner ear. CONCLUSION: LAM with ventilation tube insertion is more effective than the previous knife myringotomy.