Yu L H, Lien C F
Department of Otorhinolaryngology, Veterans General Hospital-Taipei, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 1998 Aug;61(8):479-83.
The formation of a retraction pocket of the pars flaccida remains a difficult problem for otologists to treat. It may lead to ossicular erosion and the development of a cholesteatoma, especially when the pocket is adherent to the malleus neck. We designed a new method of surgery for the treatment of small attic cholesteatomas.
From 1986 to 1996, 20 patients with a retraction pocket of the pars flaccida or a small attic cholesteatoma underwent surgery as described below. The complete lesion was removed after widening the posterior-superior bony external ear canal wall and placing pieces of conchal cartilage (usually less than 10 pieces, according to their scutum defect) lateral to the malleus neck or incus. The temporalis fascia was then laid.
The average follow-up period was 32 months. The paired t-test was used to compare the results of preoperative and postoperative air conduction and air-bone gap. The preoperative average air conduction was 31.17 dB and the air-bone gap was 15.09 dB. The postoperative average air conduction was 20.66 dB and the air-bone gap was 3.09 dB. The difference between preoperative and postoperative measurements was considered significant (p < 0.05). No recurrent retraction pockets or cholesteatomas were noted during follow-up.
Tympanoplasty for correction of a retraction pocket of the pars flaccida can prevent further attic retraction and the development of cholesteatomas. Postoperative hearing results were also encouraging.
松弛部退缩袋的形成仍是耳科医生治疗的难题。它可能导致听小骨侵蚀和胆脂瘤形成，尤其是当退缩袋附着于锤骨颈时。我们设计了一种治疗小上鼓室胆脂瘤的新手术方法。
1986年至1996年，20例松弛部退缩袋或小上鼓室胆脂瘤患者接受了如下所述的手术。在扩大外耳道后上壁骨质并在锤骨颈或砧骨外侧放置耳甲软骨片（根据盾板缺损情况，通常少于十片）后，完整切除病变。然后铺置颞肌筋膜。
平均随访期为32个月。采用配对t检验比较术前和术后气导及气骨导间距的结果。术前平均气导为31.17 dB，气骨导间距为15.09 dB。术后平均气导为20.66 dB，气骨导间距为3.09 dB。术前和术后测量结果的差异具有统计学意义（p < 0.05）。随访期间未发现复发性退缩袋或胆脂瘤。
鼓膜成形术矫正松弛部退缩袋可防止上鼓室进一步退缩和胆脂瘤形成。术后听力结果也令人鼓舞。
