Postoperative Results of Tympanoplasty Type III and IV / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The treatment goal of both chronic and cholesteatomatous otitis media is to irradicate inflammation and to improve hearing. Recently, it has become more important to improve hearing acuity, and thus ossicular reconstruction has become essential in middle ear surgery. To find out the effective method of ossiculoplasty, we analysed tympanoplasty cases, especially type III and IV by Wullstein, performed in our hospital. MATERIALS AND METHOD: 120 cases of type III and IV tympanoplasty performed from January 1995 to December 2000 were analysed. Age and sex distribution, success rate of hearing improvement, recurrence rate of infection, and extrusion rate were analysed according to implanted material and type of surgery. RESULTS: 1) Success rate of hearing improvement according to the implanted material were 35.7%, 33.3%, 43.5%, and 29.2% in fascia, TORP, PORP, and autologous ossicle, respectively. The success rate was highest for the PORP group and with the average of 37.5%. 2) Recurrence rate of infection according to implanted material were 4.8%, 4.2%, 4.3% with fascia, TORP, and PORP, respectively. Infection was the highest in the autologous ossicle (12.3%), and the average recurrence rate was 6.7%. 3) Extrusion rates according to implanted material were 12.5% (TORP), 4.3% (PORP), and 0%(autologous ossicle). The average was 5.1%. 4) Success rate of hearing improvement according to type of surgery were 51%, 46.7%, and 33.3% in atticotomy, intact canal wall mastoidectomy and open cavity mastoidectomy, respectively. The surgery which conserves the middle ear structure tended to have high success rate. 5) Recurrence rate of infection according to type of surgery were 8%, 6.7%, 6.1% in atticotomy, intact canal wall mastoidectomy, and open cavity mastoidectomy, respectively. CONCLUSION: To obtain better results by operating, we should consider the kind of implantation material and proper type of operation. For better hearing improvement, it is preferable to use TORP or PORP instead of autologous ossicles. Although TORP and PORP tend to extrude more frequently than ossicles, they are still better than autologous ossicles if recurrence of infection is considered. Therefore, it is more preferable to use biocompatible materials such as TORP and PORP with adequate type of operation for tympanoplasty III and IV cases.

Analysis of Abnormal Heal Posture and Surgical Results in the Patients with Duanes Retraction Syndrome

We evaluated retrospectively the clinical records of 46 cases of Duanes retraction syndrome. The purpose of this study is to demonstrate a clinical characteristics of this syndrome and improvement of abnormal head posture and degree of deviation in 14 cases undergoing operation. Unilateral manifestation was in 42 cases and 4 cases were involved bilaterally. Left eye was involved predominantly in 29 cases (63.0%). The frequencies analyzed according to Hubers classification were that Type I was 64.3%, Type II 7.1%, and Type III 28.6% in unilateral cases. Of unilateral cases, compensatory face turn was exhibited in 65.2% of Type I, 100% of Type II, and 60.0% of Type III. In primary position, 44.4% of Type I had esodeviation, and 100% of Type II ad 83.3% of type III had exodeviation. The major concerns of most patients or their parents were the correction of strabismus and gaze limitation, but they hardly recognized abnormal head posture. The correction of abnormal head posture and strabismus was achieved in 78.6% postoperatively.

A Clinical Analysis of the Carpal Tunnel Syndrome Patients Who Were Surgically Treated

The carpal tunnel syndrome is well known, studied and easily treatable disease as one of the entities of peripheral neuroentrapment disease. This report is based on last ten year of our experience since the January of 1987 by observing 31 hands of 21 surgically treated patients with carpal tunnel syndrome. The age range of patients was from 29 to 61 years old(average 48.70. The peak age group was six decade. Both hands were affected predominantly followed by right and left hand, 18(58%), 9(29%) and 4(13%) respectively. Tingling sensation and pain were presented in all hands followed by Tinel's sign in 21 hands(67.7%), Phalen's sign in 19 hands(61.2%) and thenar muscle atrophy in 9(29%). The postoperative results were excellent in 64.7% of patients, good 23.5%, fair 5.9% and poor 5.9%. There were no postoperative complication. From these results we stress that carpal tunnel syndrome can be treated well by surgery.