만성 중이염 수술의 임상적 연구

Abstract

Chronic suppurative otitis media is the most common diseain otolaryngologic field. Recently, the development of aseptic technique, antibiotics & operating microscope were helpful for treatment of chronic suppurative otitis media. But, there are difficult management problems in treatment of chronic suppurative otitis media. A clinical observation was performed on 127 cases of chronic suppurative otitis media who had taken middle ear surgery at Dept. of Otolaryngology of Ewha Womans University from Jan. 1977 to Dec. 1985. The results were as follows ; 1. Sex ratio of male to female is 1.2 : 1. Age distribution showed 57 cases (44.9%) in 3rd decade, 40 cases (31.5%) in 2nd decade and 19 cases (14 9%) in 4th decade. 2. Duration of diseases was 35 cases (27.7%) from 6 years to 10 years, 29 cases (22.8%) from 0 years to 5 years, 20 cases (15.7%) from 16 years to 20 years. 3. Total perforation was observed in 50 cases (39.4%), large perforation in 17 cases (13.4%), moderate perforation in 8 cases (6.3%), small perforation in 20 cases (15.7%) and granulation & polyp in 32 cases (25.2% ). 4. In bearing loss according to the degree of ear drum perforation, total absence of drum showed 60 dB loss, small sized perforation 48 dB loss. Consequently, hearing loss showed increased trend with perforation size. 5. Pathologic organism was 17 cases (32.8%) in proteus, 13 cases (25.0%) in staphylococcus and 8 cases (15.4%) in pseudomonas. 6. Routes of approach were 96 cases (75.7%) in end-aural incision and 23 cases (18.1%) in post-aural incision. 7. Type of operation were radical mastoidectomy in 70 cases (55.1%), tympanoplasty with mastoidectomy in 39 cases (39.7%), tympanoplasty without mastoidectomy in 10 cases (7.9%) and myringoplasty in 8 cases (6 3%). 8. The most common operation was radical mastoidectomy (82.7%) from 1977 to 1980 and tympanoplasty with mastoidectomy (48.0%) from 1981 to 1985. 9. Condition of ossicles were 107 cases (84.3%) in destruction, 20 cases (15.7%) in intact. The most common was total ossicular destruction (37.0%). 10. The degree of ossicle destruction was not related with drum perforation size. 11. Pathologic changes of middle ear & mastoid antrum showed granultion & cholesteatoma in 48 cases (37.8%), granulation in 44 cases (34.6%) and cholesteatoma in 20 cases (15.7%).;만성 중이염은 이비인후과학 영역에서 가장 흔한 질환으로 조기에 적절한 치료가 시행되지 않으면 청력 손실은 물론 이성두개내 합병증까지 유발하여 생명에도 위협을 주는 질환이다 그동안 치료 방법이 개선되어 왔으나 아직도 해결되지 못한 문제점들이 많이 남아 있는 실정이다. 이에 저자는 만성 중이염의 치료에 대한 여러가지 문제점을 분석 연구하여 앞으로의 수술 방법 결정에 도움이 되고자 1977년 1월부터 1985년 12월까지 만 9년간 이화여자대학교 부속병원 이비인후과학 교실에서 만성 중이염으로 수술 받은 127명을 임상 분석하여 다음과 같은 결과를 얻었다 연령별로는 20대가 가장 많았으며, 질병기간은 6년에서 10년사이가 가장 많았다. 고막 천공크기와 청력 손실 정도는 비례하였으며, 수술 방법은 1977년에서 1980년까지는 중이 근치술이 대부분 이었으나, 최근에는 고실 성형술과 유양동 삭개술을 병용하는 방법이 주였다. 원인균으로는 Proteus와 Staphylococcus가 가장 많았다.