鼓膜穿孔閉鎖術に関する研究1編 鼓膜穿孔閉鎖術に関する臨床的研究

With the purpose to study the feasibility of the methods for repairing the tympanic perforations which was left after chronic suppurative otitis media, the author performed permanent repair of tympanic perforations by three methods, namely, 1) after making a new wound on the margin of the perforation, it is closed by the transplantation of a free skin graft, 2) after making a new wound on the margin of the perforation, the closure is attempted with the transplantation of a graft from the buccal mucous membrane, and 3) first the margin of the perforation is cauterized with trichloracetic acid and then the closure is effected by patching a strip of human amniotic membrane. Following results were obtained. 1. Of the total of 43 cases receiving the repair of perforations in our clinic, the closure of the perforations was successful in 10 cases (58.8%) out of 17 that received the transplantation of human amniotic membrane; 8 cases (53.3%) out of 15 cases the free skin grafts method were used proved to be successful; and 8 cases (72.7%) out of 11 cases whose buccal mucous membrane were used as grafts proved successful. 2. Of 40 cases with central perforation the closure proved to be successful in 26 cases, while in 3 cases with marginal perforation it resulted all in failure. 3. The possibility of obtaining successful closure of the perforations is greater in those having dry middle ear cavity over one year before the operation than those with dry ear for less than one year. 4. Infection of the middle ear which had not been controlled before the surgery or occured after the surgery is one of the factors causing the failure of this operation. 5. After the repair of perforations it seems advisable to leave the graft alone without touching it until the demarcation between the graft and the tissue underneath (newly developed tympanic membrane) is completed. 6. The hearing before the operation, the preoperative hearing at the time when perforated tympanic membranes were patched with cigaret paper, and the hearing after the closure of perforations were studied and the following results were obtained. a. The hearing improvement in the average of speech range after the closure is 14.2 db compared with the gain of 9.8 db when the cigaret paper was applied before the operation. In other words, the hearing improvement after the operative closure of perforations is slightly better than that anticipated preoperatively using cigaret paper. b. The hearing is improved for all frequencies after the closure of the perforations, showing marked improvement for lower frequencies (128 cps-1024 cps).