HISTOPATHOLOGICAL STUDY OF TRANSPLANTED NASAL MUCOSA IN CASES OF OPERATIVE EAR WITH ADHESIVE OTITIS MEDIA

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  • NAGASE Dai
    Department of Otolaryngology, Showa University Fujigaoka Hospital
  • MATSUI Kazuo
    Department of Otolaryngology, Showa University Fujigaoka Hospital
  • TAKEMURA Hideki
    Department of Otolaryngology, Showa University Fujigaoka Hospital
  • KUBOTA Tetuaki
    Department of Otolaryngology, Showa University Fujigaoka Hospital

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Other Title
  • 鼓膜癒着を伴う耳手術症例に対する鼻粘膜移植部位の病理組織学的検討
  • コマク ユチャク オ トモナウ ミミ シュジュツ ショウレイ ニ タイスル ハナ ネンマク イショク ブイ ノ ビョウリ ソシキガクテキ ケントウ

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Abstract

One of the greatest concerns among otologists is the countermeasures agaimst readhesion of the new ear drum after tympanoplasty in adhesive otitis media. We think it is important to facilitate early regeneration of the middle ear mucosa, as well as to assure aeration in the middle ear cavity immediately after operation. For this reason, in patients with ear drum adhesion we attempt to minimize exposure of the middle ear bone surface as much as possible. However, in some patients with extensively exposed bone surface in the middle ear cavity, we transplant mucosa of the inferior turbinate to the bone surface to facilitate epitheliazasion. To investigate the morphological findings of the transplanted inf erion turbinate, we obtained biopsy specimens at the second stage operation. From May 1993 to December 2000 we performed nasal mucosa transplantation on 45 cases of the ear with adhesive otitis media: thirty-one cases of cholesteatoma with adhesive otitis media and fourteen cases of postoperative ear (20 males, 25 females) . The method of operation was canal wall down typanoplasty with canal reconstruction using auricular cartilage. Usually nasal mucosa grafts are placed on the promontrium. Among the 45 cases, 16 cases were carried out by single-stage surgery and the remaining 29 cases, by staged surgery. Four cases experienced recurrence of adhesion. No recurrent cholesteatoma occurred in al cases during the follow-up period. At the second stage operation, we obtained biopsy specimens of the middle ear mucosa, where the nasall mucosa was transplanted. We investigated the morphological findings of 24 cases; 5 cases could not be investigated because the biopsy speciments were too little. 50% was pseudostratif ied ciliated columnar epithelium which is similar to nasal mucosa. Glandular tissue could be seen under the epithelium in 13 out of 24 cases. Among most of the 13 cases, glandular tissur decreased in quantity and atrophic findings could be seen as well. We consider that nasal mucosa adapts to the middle ear environment and survives at a high rate. It is considered that this operative method is useful for preventing the recurrence of adhesion by securing the middle ear cavity.

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