外耳道皮瓣整形術を行はざる中耳根治手術の経驗

　1．緒言

　著者等の一人立木^1）は昭和23年8月東京医事新誌々上に「中耳根治手術論」を寄稿し，中耳根治手術施行上の理念の変轉に関してその大要を述べた．

　然るに当時著者等の教室に於ても亦凡そ次の四つの基礎的な考の下に保存的中耳根治手術を行ひつゝあつた．即ち

　（1）表皮化した大きな耳後孔を作ることは必要ではない．出來るだけこれは肉芽を挙げて縮少せしめてよいではないか．

　（2）又実際吾々が根治手術の対象とするものはレントゲンで診ても明かな樣に多くの場合胞？の発育が抑制されて居るものであるから症例によつてはそう耳後孔は大きくなり得ない．又そう大きくする必要もない．殊に象牙質化したものでは乳樣突起そのものが恰も迷路殼の樣な緻密な骨質で出來て居る．

　仍て

　（3）極端な場合を考えれば乳樣洞を底として外耳道の後上方に廣く開放した手術創を作れば足りる筈である．又この場合後方或は下方に向い稍々廣い手術竈が出來たとしてもそれは結局五十歩百歩の相違と見做し得る性質のものではないか．

　（4）一般の保存的根治手術の概念に從つて鼓膜や耳小骨には出來る丈け手を着けない．

　以上四つの考である．

　Tsuiki and his associates say that, since 1947, they have adopted conservative means for treatment of otitis media that equired radical operation. That the method is in close agreement with general conservative methods in so far as middle ear ossicles and the tympanic membrane are untonched, nothing done on external auditory canal by way of plastic operations and, the postauricular, incision wound is closed by primary suture without resorting to gauze packing, in the procedure. Evaluations on the results of otic operations resolve upon two points which, from the standpoint of the patient as well as the operator, are essentially important in attainment, namely. improvement of hearing and, completely dry external canal.

　With these points in view results of operations by this method in majority of cases, though not altogether unfaltering, are favorable and in addition a remarkable shortening of time of healing period is also seen. Of 26 cases operated upon, 21 showed improvement in hearing while, 5 with no changes but, there were none that showed decreased hearing becaues of the treatment. Completely dry ears are obtained in 23 cases and the remaining 3 cases continued to discharge at the time when the patients are discharged from the hospital.