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Objectives Autologous costal cartilage is a promising alternative for mastoid obliteration. However, donor-site morbidities of the chest wall limit the use of this graft. To address this issue, we have developed a minimally-invasive technique of harvesting costal cartilage and report donor site morbidity associated with the procedure. Methods Donor site morbidities were evaluated for 151 patients who underwent costal cartilage harvest, canal wall down mastoidectomy, and mastoid obliteration. Pain and cosmetic concern were evaluated via visual analogue scale (VAS). Scars were evaluated via the modified Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Postoperative complications were assessed during the follow-up period. Results The mean duration of noticeable pain was 5.3 days post operation. The mean VAS score for pain was 3.0 of 10 on the first day after the operation and gradually declined. At the 6 months post operation, the mean VAS cosmetic score at the costal cartilage harvest site was 0.6 of 10. The mean VSS score was 9.5 out of 10 total, and the mean POSAS score was 23.27 out of 110 total. Conclusion The minimally-invasive chopped costal cartilage harvest technique resulted in acceptable pain, cosmetic concern, and postoperative complications for most patients. There were no major postoperative complications. Costal cartilage is an acceptable donor for mastoid obliteration in canal wall down mastoidectomy, especially in the context of the extremely low donor site morbidity of the minimally-invasive technique presented in the study.

Matrix removal by a non-suction technique with intraoperative dexamethasone injection is a safe and effective management modality, regardless of fistula size.Our goal was to evaluate the outcome of hearing treated by non-suction technique with intraoperative dexamethasone injection.This was a retrospective chart review of 720 mastoidectomy cases for cholesteatoma, performed at our tertiary otolaryngologic care centers between 2005 and 2012. A total of 17 patients with a unilateral labyrinthine fistula were encountered.There was no recurrent cholesteatoma in any of the patients. In all cases, the matrix was removed by intraoperative dexamethasone injection with a bimanual non-suction technique, regardless of the fistula size. None of the patients showed deteriorated bone conduction (BC). Averaged BC was unchanged (n = 13) or improved (n = 4) in all patients and did not decrease by 10 dB more in any patient. The mean threshold of postoperative BC was significantly improved compared with preoperative mean threshold. Fistulae on the preoperative CT scans ranged from 1.41 to 7.12 mm and averaged 2.89 mm. There was no correlation between the fistula size and the postoperative BC level. Even with a large fistula, postoperative hearing preservation was possible with one-stage matrix removal.

Objective Oxytetracycline and ilomastat are inhibitors of matrix metalloproteinases (MMPs). Their efficacy in protecting against cochlear damage induced by the intratympanic instillation of lipopolysaccharide (LPS), as a means of inducing labyrinthitis, was investigated. Materials and methods Experiments were performed in 21 young male guinea pigs. Intratympanic instillation of LPS was done in the control group (n = 7). Intratympanic instillation of oxytetracycline or ilomastat was done after LPS instillation in the experimental group. Measurements of auditory brainstem response (ABR) and cochlear blood flow (CBF) were performed. The organ of Corti was evaluated by field emission scanning electron microscopy (FE-SEM). The blood–labyrinth barrier (BLB) integrity was evaluated with Evans blue uptake. Gelatin zymography was used to assess the expression of active MMP-2 and MMP-9. Results Ears treated with MMP inhibitors were significantly protected from hearing loss compared to the LPS group. In LPS group, there was a significant decrease of CBF. However, experimental group displayed a statistically significant recovery of CBF. FE-SEM revealed hair cell damage in the LPS-treated group, but hair cells presented a normal appearance in MMP inhibitors. The LPS group showed a marked increase of Evans blue extravasation in the cochlea. However, MMP inhibitors significantly reduced the BLB opening. Active MMP-9 was expressed in the LPS group. Treatment with MMP inhibitors attenuated active MMP-9 expression. Conclusion The MMP inhibitors oxytetracycline and ilomastat protect from cochlear lateral wall damage caused by LPS-induced labyrinthitis.

To describe our surgical technique and compare the results of obliteration materials.Fifty patients over a 7-year period were evaluated retrospectively. Out of these 50 consecutive patients, 29 had recurrent chronic otitis media (COM) with or without cholesteatoma and 21 patients had old open cavities. Efficacy of mastoid obliteration was assessed by an electronic chart review, otoendoscopic findings, temporal bone computerized tomography (CT) images, and postoperative caloric test.Among 50 patients, inferiorly-based periosteal flap was used in 25 patients (50%) and anteriorly-based periosteal flap was used in the other 25 patients. Tympanic membrane and newly-formed external auditory canal wall was intact in 48 patients (96%). The newly-formed EAC provided sufficient aeration, and satisfactory aesthetic appearance. None of our patients complained of vertigo triggered by cold air or water. There was no significant difference in the caloric test results between the operated ear and the normal ear. No difference was observed in the caloric test between the bone pate and costal cartilage groups.Our results indicate that mastoid obliteration using autogenous bone pate or costal cartilage is helpful in improving the outcomes of revision canal wall-down mastoidectomy in patients with an old radical cavity and recurrent COM or cholesteatoma.

Background and objective Polylactide film (PLF) is used to prevent postoperative peridural adhesion in spinal surgery. Up until now, the antiadhesive effect of bioresorbable PLF in ear middle surgery has not been reported. The purpose of this study is to evaluate the antiadhesive effect of PLF in guinea pigs serving as a model for middle ear mucosal trauma. Materials and methods The animals were divided into two groups: the PLF group and the silastic sheeting group. There were seven guinea pigs (fourteen ears) in both groups. Under aseptic conditions, the middle ear mucosa was abraded using a pick inserted transbullaly. A PLF or silicone sheet was then placed into the guinea pigs’ middle ear cavities. The auditory brainstem responses (ABRs) were assessed preoperatively and at three weeks postoperatively while the animals were under general anesthesia. A histopathological study was performed 3 weeks after the operation. Results The difference between the ABR results before the operation and three weeks postoperatively were not statistically significant. The adhesion formation did not appeared in either group. Prominent fibrous capsule formation and inflammation were observed in the silastic sheeting group, but not in the PLF group. Mild fibrous thickening of regenerated mucosa was observed in the PLF group. Conclusion From our results, bioresorbable PLF is nonototoxic and biocompatible with the guinea pig's middle ear cavity by short-term evaluation. Further long-term evaluation study is necessary before clinical application.

Objective: Autologous cartilage such as conchal cartilage has been commonly used as an obliteration material of the mastoid, however sufficient amount could not be harvested. We evaluate the use of autologous costal cartilage for obliteration of mastoid cavity after canal wall down mastoidectomy.Method: Retrospective review of the patients who underwent mastoid obliteration with autologous costal cartilage after CWD was performed. Costal cartilage was harvested at 7th or 8th rib with middle ear surgery. Pre- and postoperative audiometry, neodrum findings, temporal bone CT and complications including wound infection and canal wall displacements were evaluated.Results: A total of 39 patients (29 women, 10 men) with a mean age of 52.5 years underwent the procedure. The follow-up period ranged from 9 months to 14 months (mean period, 11.4 months). For all cases in the study, complications such as postoperative wound infection, perforation, and canal wall destruction did not develop. Small skin dehiscence at t...

최근 10여 년간 급속도로 발전하고 있는 조직공학은 인체 조 직과 기관을 재생하는 가능성을 열어 놓았으며 새로운 치료로 등장하기 시작하였다. 고막 천공은 외상, 중이 염증, 의인성 손상, 환기관 탈출 등 매 우 다양한 원인으로 발생한다. 대부분의 급성 고막 천공은 자 연스럽게 회복되지만 약 10% 내외에서 치유되지 않고 천공된 상태로 만성화된다. 만성 고막 천공은 그대로 놔둘 경우 청력의 장애나 반복되는 이루를 야기할 수 있어 고막성형술(myringoplasty)이나 고실성형술(tympanoplasty) 등 수술적 처치가 시행되어 왔다. 이런 수술들은 비교적 합병증이 낮고 성공률이 높은 수술이지만 수술에 따른 비용 발생 및 소아나 고령, 기저 질환을 동반한 경우 수술을 시행하는 데 따른 위험도는 환자 와 의사 모두에게 부담이 된다. 따라서 수술을 대신하여 외래에 서 외이도를 통하여 고막 재생을 유도하는 방법은 가장 합리적 이며 이상적이다. 일반적으로 고막은 얇고 투명한 막으로, 케라틴 편평 상피 외 층(keratinizing squamous epithelial outer layer), 섬유성 중간 층(fibrous middle layer), 점막내층(mucosal inner layer)의 세 개의 층으로 구성된다. 천공된 고막의 폐쇄는 일반적으로 고 막 상피(epithelium)의 이동(migration)으로 이루어진다. 그러나 자연적으로 폐쇄 치유된 투명한 고막에는 섬유성 중간층(fibrous middle layer)이 없다. 세 층이 아닌 두 개의 층으로만 이 루어지게 되는 것이다. 이렇게 되면 고막은 청각학적으로 최적 인 상태는 아니게 되고 중이에 염증 및 삼출물 등 병적 질환이 생겼을 경우 고막이 함몰되거나 재천공될 확률이 높아진다. 특 히 테니스 라켓과 비슷한 섬유성 중간층은 고막 진동에서 중 요한 역할을 한다. Current Status of Tympanic Membrane Regeneration Using Tissue Engineering Approach

골종(osteoma)은 천천히 성장하고 비교적 흔치 않은 양성 종양으로 이비인후과에서는 주로 부비동이나 하악골에서 발 생된다. 이과 영역에서 논의되는 골종은 대부분 외이도에서 발 견되었고 중이강 내에서 발견되는 경우는 드물다. 중이 골종 은 발생위치에 따라 이소골 연쇄에 영향을 미쳐 전음성 난청 을 일으키는 것으로 알려져 있지만 특별한 증상 없이 수술 중 우연히 발견되는 경우가 대부분이다. 중이 골종 중 이소골(ossicle)을 침범한 골종(osteoma)에 대한 논문은 현재까지 세계 적으로 매우 드물게 보고되고 있으며 특히, 진주종(cholesteatoma)과 동반된 이소골 골종은 2예만 보고되고 있다. 하지 만 2예는 모두 선천성 진주종과 동반된 경우였고 후천성 진 주종에 동반된 이소골 골종은 아직까지 국내외적으로 보고된 바 없다. 저자들은 일차성 후천성 진주종성 중이염(primary acquired cholesteatoma) 환자를 수술하던 중 진주종과 동반된 침골 골종(incudal osteoma) 1예를 치험하였기에 문헌고찰과 함께 보고하는 바이다.

Received December 9, 2010 Revised January 25, 2011 Accepted January 26, 2011 Address for correspondence Joon Kyoo Lee, MD, PhD Department of OtolaryngologyHead and Neck Surgery, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun 519-763, Korea Tel +82-61-379-7760 Fax +82-61-379-7761 E-mail joonkyoo@chonnam.ac.kr Background and ObjectivesZZWhether to sacrifice the posterior branch of great auricular nerve (GAN) during parotidectomy is disputatious. This study was to provide a guideline for decision-making. Subjects and MethodZZThirty-two patients who underwent parotidectomy due to parotid mass were randomized into two groups. Three patients who underwent further treatment were excluded. Fourteen patients underwent classic parotidectomy by sacrificing GAN whereas 15 patients underwent surgery that preserved the nerve. A two-point discrimination test, sensation of light touch, sharp instrument, blunt instrument and temperature were evaluated preoperatively, and at 7 days, 1, 3, 6, 12 months and 45 months, postoperatively. Patients’ preference for the operation time to preserve the nerve was also evaluated. ResultsZZThe mean preservation time was 156 seconds. There was no difference in touch sensation, preoperatively, between the two groups. The two-point discrimination test of the infra-auricular area showed significant differences at 1 week postoperatively (p