Clinical assessment of patients with chronic otitis media with cholesteatoma

Yıl 2002, Cilt: 9 Sayı: 4, 263 - 266, 30.08.2002

Muhammet Tekin Üstün Osma Faruk Meriç İsmail Topçu

Öz

Objectives: We evaluated clinical features and treatment results of patients with chronic otitis media COM with cholesteatoma.Patients and Methods: The study included 83 patients 53 males, 30 females; mean age 27.5 years; range 7 to 60 years who were treated for COM with cholesteatoma. Ali patients undervvent otoscopic examination, audiometric investigation, temporal bone computed tomography, and when necessary, cranial tomography. Öpen or closed mas- toidectomy was performed depending on the extent of cholesteatoma and perioperative appearance of the ear.Results: Open- and closed-technique mastoidectomies were performed in 64 and 19 patients, respectively. Ossicular chain defects were observed in 90.3% of patients, and 9.7% had no detectable ossicular chain. Cranial complications were present in 28%. Of patients who had undergone öpen mastoidectomy, 75% had dry ears, 11% had recurrent ear discharge, and 14% required revision mastoidectomy because of recurrence. Of those who had been treated by closed-technique, 79% had dry ears, vvhereas 21% required revision mastoidectomy. Recurrent cholesteatoma was detected in 85% of patients during revision mastoidectomy.Conclusion: We prefer open-technique mastoidectomy in chronic otitis media patients with extensive cholesteatoma, bone destruction, and hearing impairment. This choice mainly relies on the socioeconomic status of patients and difficulty in having patient compliance with follow-up Controls.

Anahtar Kelimeler

Cholesteatoma/complications/surgery, ear diseases/ complications/surgery, mastoid/surgery, mastoiditis/etiology/surgery, otitis media/complications/surgery, recurrence, tympanoplasty

Kolesteatomlu kronik otitis media: Olguların klinik değerlendirilmesi

Öz

Amaç: Çalıflmada kolesteatomlu kronik otitis media tanısıyla tedavi gören KOM hastaların klinik özellikleri ve tedavi sonuçları değerlendirildi. Hastalar ve Yöntemler: Çalıflmaya kolesteatomlu KOMtanısı konan 83 hasta alındı. Olgular, otoskopik muayene, odyometrik inceleme, temporal kemik bilgisayarlı tomografisi;komplikasyon geliflen olgular da beyin bilgisayarlı tomografisi ile değerlendirildi. Kolesteatomun yaygınlığı ve kulağın ameliyat sırasındaki görünümü değerlendirilerek açıkveya kapalı teknik mastoidektomi uygulandı.Bulgul a r : Olguların 64’üne açık, 19’una kapalı teknik mastoidektomi uygulandı. Olguların %90.3’ünde kemikçik zincirdefekti saptandı; %9.7’sinde ise kemikçik zincir izlenmedi.Kranyal komplikasyon oranı %28 bulundu. Ameliyat sonrasıizlemde, açık kavite mastoidektomi yapılan hastaların%75’inde kuru kulak elde edilirken, %11’inde tekrarlayan kulak akıntısı gözlendi; %14’ünde nüks nedeniyle revizyonmastoidektomi yapıldı. Kapalı kavite mastoidektomi yapılanolguların %79’unda kuru kulak elde edildi; %21’inde revizyonmastoidektomi yapıldı. Revizyon mastoidektomi yapılan olguların %85’inde nüks kolesteatom saptandı.Sonuç: Yaygın kolesteatoma, kemik destrüksiyonu bulunan, iflitmenin kötü olduğu olgularda açık teknik yaklaflımıtercih ediyoruz. Bunun bafllıca nedenlerinden biri, hastaların, bölgemizin sosyoekonomik koflulları nedeniyle kontrollere gelmemesidir

Anahtar Kelimeler

Koleasteatom/komplikasyon/cerrahi, kulak hastalıkları/komplikasyon/cerrahi, mastoid/cerrahi, mastoidit/etyoloji/cerrahi, otitis media/komplikasyon/cerrahi, nüks, timpanoplasti

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