Cem UZUN, Recep YAĞIZ, Ahmet KARASALİOĞLU

Kolesteatoma cerrahisinde yeni bir teknik: CHAT

Amaç: Heermann’ın “kıkırdak palisad timpanoplastisi“ ve Tos’un “modifiye kombine yaklaşım timpanoplastisi“ ile ilgili yapmış olduğumuz çalışmalar sonucu geliştirdiğimiz Kombine Heermann ve Tos tekniği (Combined Heermann And Tos: CHAT) ile yaygın kolesteatoma tedavisi yaptığımız hastalar analiz edildi. Hastalar ve Yöntemler: Kombine Heermann ve Tos tekniği uygulanan 35 hastanın 37 kulağı çalışmaya alındı. Her hastada arka-üst kemik anulus genişce turlanıp, transmeatal attikotomi ve arka duvarının korunduğu kortikal mastoidektomi yapıldı. Kolesteatoma çıkarıldıktan sonra gerekirse ossiküloplasti yapıldı ve kulak zarındaki perforasyon, kemik anulus ve skutumdaki açıklık palisad tekniği ile onarıldı. Son kontrolde otoskopik bulgular değerlendirilip, odyolojik bulgular ameliyattan öncekilerle karşılaştırıldı (Eşleştirilmiş t-testi). Bulgular: Ortanca yaş 33 (6-57), ortalama takip süresi 30 ay (aralık: 6-60; standart sapma: 19) idi. Hiçbir kulakta ameliyat öncesi ve sonrası komplikasyon yoktu. Biri lokal, toplam iki rekürrens (%5) saptandı (eradikasyon: %95). Ameliyat öncesi ve son kontroldeki işitme eşiği ortalaması 45 dB (standart sapma: 14) ve 35 dB (standart sapma: 16) (p

Anahtar Kelimeler:

Orta kulak iltihabı, Ameliyat sonrası dönem, Tekrarlama, İşitme, Otolojik cerrahi prosedürler, Kolesteatom

A new technique in cholesteatoma surgery: CHAT

Objectives: Patients with extended cholesteatoma who underwent Combined Heermann And Tos (CHAT) technique, which we developed depending on our studies on Heermann’s “cartilage palisade tympanoplasty“ and Tos’ “modified combined approach tympanoplasty“, were analyzed. Patients and Methods: The study included 37 ears of 35 patients, in whom CHAT technique was performed. Posterior-superior bony annulus was widely drilled, transmeatal atticotomy and cortical mastoidectomy with preservation of posterior ear canal wall were performed in each patient. After ossiculoplasty, perforation of the eardrum, opening at bony annulus and scutum were reconstructed with the palisade technique. At the final evaluation, otoscopic and audiologic findings were evaluated and compared (Paired Sample t-test). Results: Median age was 33 (6-57), mean follow-up period was 30 months (range: 6-60; standard deviation: 19). There was no complication in any patient before or after the surgery. There was two (5%) recurrent cholesteatomas (eradication: 95%), one of which was local. The mean hearing and air-bone gap preoperatively versus in last evaluation were 45 (standard deviation: 14) vs 35 dB (standard deviation: 16) (p<0.0001) and 29 (standard deviation: 11) vs 21 dB (standard deviation: 11), respectively (p<0.001). Conclusion: We conclude that CHAT technique is quite successful in the eradication of extensive cholesteatoma with satisfactory results in hearing, although it is a one-stage, canal wall up closed technique.

Keywords:

Otitis Media, Postoperative Period, Recurrence, Hearing, Otologic Surgical Procedures, Cholesteatoma,

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