Erdem Atalay ÇETİNKAYA, İBRAHİM ÇUKUROVA, Levent OLGUN, Raci KABAKÇI

Attik kolesteatom fonksiyonel cerrahisinin uzun dönem sonuçları

Attik kolesteatom fonksiyonel cerrahisinin uzundönem sonuçları Amaç: Çalışmanın amacı, attik kolesteatom cerrahisi ve ossiküloplastisinde kullanılan rekonstrüksiyon malzemeleri ile ilgili cerrahi tekniklerden elde edilen uzun dönem sonuçların değerlendirilmesidir. Yöntem:Uygulanan prosedürlerin sonuçları, uzun dönem takibi içinulaşılabilen 30 hastada değerlendirildi. Hastalara attikotomi + timpanoplasti , intakt kanal timpanoplasti (ICWT) ve açık kanal timpanomastoidektomi (CWDT) prosedürlerinden biri uygulandı. Ameliyatsonrası şikayetler, otoskopi, odyometri sonuçlarına göre prosedürlerdeğerlendirilip tedavi öncesi ile karşılaştırıldı. Bulgular:Yirmi altı (%85) hastada preoperatif ve postoperatif havakemik yolu farkları karşılaştırıldığında 5-35 dB işitme kazancı görüldü. En büyük kazanç ICWT tip II cerrahi ile elde edildi. Mikroskobik kulak zarı değerlendirilmesinde, açık teknik grubundaki hastaların%30 ve kapalı teknik grubunda olanların yaklaşık %20'sinde değişikderecelerde retraksiyon izlendi. Altı yıllık takipte açık gruptaki hastaların %55 ve kapalı grupta olanların %45'inde normal bulgular mevcuttu. Sonuç:Attik kolesteatomun tamamen çıkarılması açık teknikler gerektirebilir. Kapalı tekniklerle karşılaştırıldığında, açık teknikte deişitme korunması ve kemikçik rekonstrüksiyonu sağlanabilir. Stapesve manubrium malleinin iyi durumda olduğu durumlarda yeni geliştirilen biyomalzemeler kullanılarak çok iyi sonuçlar elde edilebilir.

Long-term outcomes of functional surgery for attic cholesteatoma

Objective:To evaluate the long-term findings obtained using microscopic approaches to attic cholesteatoma and with respect to thereconstruction materials used in ossiculoplasty. Methods:The results of these procedures were evaluated in 30 of thepatients who subsequently returned for follow-up. One of the surgical techniques among atticotomy + tympanoplasty, intact canal walltympanoplasty (ICWT) and canal wall-down tympanomastoidectomy(CWDT) was performed. The responses to procedures based onpostoperative complaints, otoscopy and audiometry results were evaluated and compared with those pre-treatment. Results: A comparison of the preoperative and postoperative air-bonedifferences in 26 (85%) patients showed a hearing gain of 5-35 dB. Thelargest gain was achieved with ICWT type II surgery. Evaluation of thetympanic membrane by microscopic otoscopy showed various degreesof retraction in 30% of the patients in the open group and approximately 20% of those in the closed group. After a six-year long-term followup, 55% of the patients in the open group and 45% of those in theclosed group had normal findings. Conclusion:An adequate exposure allowing full removal of an atticcholesteatoma may require an open technique. Compared to closedtechniques, this also allows hearing preservation and ossicular reconstruction. Good results in the reconstruction of the ossicles can beachieved using recently developed biomaterials, assuming that the stapesand manubrium mallei are in good condition.

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1. Aky>ld>z N. Kulak hastal>klar> ve mikrocerrahisi. Vol. I. Ankara: Bilimsel T>p Yay>nevi; 1998. p. 354-418.
2. Deniz M, Uslu C, Koldafl C, Deniz B. Which technique is better for cholesteatoma surgery? B-ENT 2015;11:109-15.
3. Minovi A, Venjacob J, Volkenstein S, Dornhoffer J, Dazert S. Functional results after cholesteatoma surgery in an adult population using the retrograde mastoidectomy technique. Eur Arch Otorhinolaryngol 2014;271:495-501.
4. Tos M. Removal of attic cholesteatoma in canal wall down mastoidectomy. In: Manual of middle ear surgery. Vol. 2. New York, NY: Thieme Medical Publishers, Inc; 1995. p. 241-5.
5. Buckingham R. Atticotomy with presevation of ossicular chain and middle ear intubation as a treatment for small epiympanic cholesteatomas. In: Tos M, editor. Cholesteatoma and mastoid surgery. Amsterdam: Kugler & Ghedini Publications 1989; p. 901-3.
6. Tos M. Classic intact canal wall mastoidectomy. In: Manual of middle ear surgery. Vol. 1. New York, NY: Thieme Medical Publishers, Inc; 1995. p. 128-130.
7. Ramakrishnan Y, Kotecha A, Bowdler DA. A review of retraction pockets: past, present and future management. J Laryngol Otol 2007;121:521-5.
8. Morimitsu T, Tono T, Makino K, Miyanaga S, Ushisako Y. Improvement of the surgical technique of anterior tympanoplasty in cholesteatoma. Rev Laryngol Otol Rhinol (Bord) 1995;116: 369-71.
9. Fiedler T, Boeger D, Buentzel J, et al. Middle ear surgery in Thuringia, Germany: a population-based regional study on epidemiology and outcome. Otol Neurotol 2013;34:890-7.
10. Sonkhya N, Mittal P, Sonkhya D. Intact canal wall tympanomastoid surgery: 10 years experience. Indian J Otolaryngol Head Neck Surg 2012;64:319-25.
11. Kos MI, Castrillon R, Montandon P, Guyot JP. Anatomic and functional long-term results of canal wall-down mastoidectomy. Ann Otol Rhinol Laryngol 2004;113:872-6.
12. Karakafl M, Bal>kç> H, Özkul M, Çelebi fi, Bayram Ö, Bayram AA. Complications of chronic otitis media: a retrospective analysis of 1293 cases. J Med Updates 2014;4:43-8.
13. Tos M, Lau T. Hearing after surgery for cholesteatoma using various techniques. Auris Nasus Larynx 1989;16:61-73.
14. Tos M, Lau T. Attic cholesteatoma. Recurrence rate related to observation time. Am J Otol 1988;9:456-64.
15. Ayache S, Tramier B, Strunski V. Otoendoscopy in cholesteatoma surgery of the middle ear: what benefits can be expected? Otol Neurotol 2008;29:1085-90.
16. Alves RD, Cabral Junior F, Fonseca AC, Bento RF. Mastoid obliteration with autologous bone in mastoidectomy canal wall down surgery: a literature overview. Int Arch Otorhinolaryngol 2016;20:76-83.
17. Deveze A, Rameh C, Puchol MS, Lafont B, Lavieille JP, Magnan J. Rehabilitation of canal wall down mastoidectomy using a titanium ear canal implant. Otol Neurotol 2010;31:220-4.
18. Murphy TP. Hearing results in pediatric patients with chronic otitis media after ossicular reconstruction with partial ossicular replacement prostheses and total ossicular replacement prostheses. Laryngoscope 2000;110:536-44.
19. Berçin S, Kutluhan A, Bozdemir K, Yalçiner G, Sari N, Karamese O. Results of revision mastoidectomy. Acta Otolaryngol 2009;129: 138-41.
20. Lailach S, Zahnert T, Lasurashvili N, Kemper M, Beleites T, Neudert M. Hearing outcome after sequential cholesteatoma surgery. Eur Arch Otorhinolaryngol 2015 Sep 3. doi:10.1007/s00405- 015-3767-6
21. Ernst A, Todt I, Wagner J. Safety and effectiveness of the Vibrant Soundbridge in treating conductive and mixed hearing loss: a systematic review. Laryngoscope 2015 Oct 15. doi:10.1002/lary.25670