鼓室成形術に関する2・3の工夫と経験—術後経過の良好な新方法の紹介

　I．緒言

　耳漏の根治と聴力改善を目的とする鼓室成形術は近年の学会の話題でもあり，10年来細部に亘る検討がなされている。我が邦においても後藤（修）・風間・高原（滋）・後藤（敏）をはじめ諸家によつて手術上の諸問題が漸次解明されつつある。本手術では優れた成績が得られるにも拘らず，設備と手技上の制約がその普遍化を阻んでいる様に思われる。私は昨年の総会で啓発される処が多く，以後上記の制約を無視して積極的に本手術を企図した。従て現在30余耳を手術し得たに過ぎないが，初期の例において幸運に恵まれ術後経過の良好な一方法を考案することが出来た。その経緯は別稿に譲り，今回は目下行つっいる術式について紹介し各位の批判・御追試を得たいと思う。

There is very little difference between the hearing in Wullstein's Type Ⅱ and Ⅲ theo-retically. To obtain similar improvements in both types, new techniques had been devised and the results in 32 cases were observed.

Operations were done under local anaesthe-sia by endaural route with the skin of the external canal. During the operation the skin is reserved as a canal flap pulled out to the meatus facing undersurfaces each other (Fig. I a). Remants of the drum are removed and do not be used. Not only the non-perforated drum but also the incus are often sacrificed to remove the cholesteatoma. The bridge is removed, the tympanic sulcus is scraped and flattenned. The canal skin is incised as shown in Fig. I b, and the pedicle flap is replaced obliquely across the auditory canal, thereby its posterior upper portion is touched onto the stapes (Fig. I c). Fragments of mucous membrane in the tympanum are enough to reepithelialize the deep tympanoplastic cavi-ty. During the healig period it is observed that the flap is gradually retracted changing into the extended drum which improves the high tone deafness (Fig. 2). On the other hand, removal of the tympanic sulcus pre-vents retraction of the drum, and the well-preserved cavity with a large drum contri-butes to repair of the low tone deafness.Results in 22 cases are shown in table 1.

In tympanoplasty, therefore, oblique repla-cing of the flap and removal of the tympa-nic sulcus are advocated to enlarge the drum, deepen the cavity, and insure more adequate fixation of the drum to ossicular continuity or the stapes. In spite of its simplicity, myprocedure of"enlarged tyrnpanostapedioplas-ty"or"tympanoplasty with a deep tympa-num using the canal pedicle flap" has a rea-sonable possibility to obtain similar improve-ments in types Ⅱ and Ⅲ, and may solve many difficulties in tympanoplasty.