[Evaluation of hearing results after tympanoplasty according to the classification of the development degree for pars flaccid cholesteatoma].

Our surgical treatment for middle ear cholesteatoma is based on the following 2 concepts: (1) Preservation of the physiological morphology and function of the middle ear, that is, maximal preservation of the posterior wall of the external auditory meatus and the middle ear mucosa and (2) Careful resection of the matrix membrane of the cholesteatoma through the continuity of the matrix membrane. In case the cholesteatoma matrix membrane is ruptured, a staged operation should be performed to prevent the development of residual cholesteatoma from the residual matrix. In this study, we classified a total of 238 cases of the pars flaccida cholesteatoma primary operated on Osaka Red Cross Hospital between January 2006 and March 2008 according to the Classification and Staging of Cholesteatoma proposed in 2010. The age of the patients ranged from 4 to 79 years (average: 49.8 years) and there were 123 males and 115 females. Follow up ranged from 1 year to 5 years with a mean follow-up period of 47.8 months. Regarding the stage, 38 (16.0%) ears had stage I cholesteatoma, 155 (65.1%) ears had stage II, and 45 (18.9%) ears had stage III. The successful outcome rate was 97.4% for stage I, 78.7% for stage II and 60.0% for stage III. The rate of the residue and the postoperative recurrence was 2.5% and 4.2%.

Ear-pick injury as a traumatic ossicular damage in Japan.

This retrospective study examined the etiology and treatment results for traumatic, conductive hearing loss in 22 patients who underwent surgery between 1998 and 2008 at Osaka Red Cross Hospital. All patients underwent computed tomography (CT) of the temporal bone preoperatively. The ear surgery comprised closure of the ruptured tympanic membranes and restoration of the sound-transmitting function of the ossicular chain. Their mean age was 30.3 years, and the average delay from injury until treatment was 6.0 years. Of the injuries due to foreign-body insertion, the most common cause was ear-pick injury. Incudostapedial disarticulation was the most common finding, which was diagnosed preoperatively using CT in seven cases and identified at surgery in 15 cases. Closure of the air-bone gap to within 10 and 20 dB was observed in 50.0 and 68.2% of the patients, respectively. The hearing threshold improved by 10 dB or more in 16 (72.7%) patients. If no improvement in hearing loss follows the absorption of hemotympanium or closure of an eardrum perforation, dislocation of the ossicular bones should be suspected. Ossicular reconstruction following trauma produces more stable and better hearing results, even after delayed treatment.

Basic fibroblast growth factor combined with atelocollagen for closing chronic tympanic membrane perforations in 87 patients.

OBJECTIVE: To present the clinical results of closing chronic tympanic membrane (TM) perforations using basic fibroblast growth factor (bFGF) combined with an atelocollagen/silicone bilayer membrane patch. STUDY DESIGN: Closure of TM perforations in 87 patients was attempted using bFGF, which is thought to promote the regeneration of TM tissues by facilitating the growth of fibroblasts and collagen fibers. METHODS: Under an operating microscope, the margin of the perforation was trimmed, and a piece of an atelocollagen/silicone bilayer membrane was placed in the perforation with the silicon layer facing outward and then infiltrated with 0.1 ml of trafermin. Data obtained from patient records included patient age, perforation size, and duration of treatment, with a focus on hearing improvement and complete TM closure. RESULTS: The mean perforation size before treatment was 14.4%. Complete closure of the TM perforation was achieved in 80 patients (92.0%), whereas pinholes remained in 5 patients (8.7%), and small perforations were observed in 2 patients (2.3%). In the patients with complete closure, the TM perforations closed after an average 1.8 treatments, and hearing improved by 13.6 dB. CONCLUSION: This study demonstrated that bFGF combined with atelocollagen is effective for the conservative treatment of TM perforation.