Læknablaðið - 15.02.1988, Side 33

LÆKNABLAÐIÐ
55
NÝR DOKTOR í LÆKNISFRÆÐI - STEFÁN SKAFTASON
Nýlega varði Stefán Skaftason læknir
doktorsritgerð sína »Otosurgery in Iceland
1970-80. - A clinical study of 1,001 cases operated
on by the author«, við Háskóla íslands.
Andmælendur voru prófessor dr. med. Otto
Meurman frá Turku í Finnlandi og fyrrverandi
yfirlæknir dr. med Ole Bentzen við
Heyrnarmiðstöð danska ríkisins í Árósum.
Fjallar ritgerðin um 952 aðgerðir höfundar á
háls-, nef- og eyrnadeild Borgarspítalans í
Reykjavík og 49 á háls-, nef- og eyrnadeild í
Kalmar í Svíþjóð. Útdráttur ritgerðar hans fer hér
á eftir.
The dissertation consists of six chapters covering
the otological problems and the resultant surgical
techniques used in treatment, together with a full
appendix giving detailed data on all the patients
treated and the codes used to describe patient
categories and treatments, a total of 171 pages.
The body of the text is divided into 6 chapters.
The first is historical and lists and recounts the
work of all Icelandic otorhinolaryngologists who
were in practice prior to 1970, or the beginning of
the present study. This historical review covers
the otosurgery performed before the opening of
the Ear, Nose and Throat Department at the
Reykjavik City Hospital. The first chapter also
covers the work of the ENT Department, and the
staffing and services both of the Outpatient
Department, and the surgical ward for the period
in question. The chapter concludes with a map of
Iceland and the geographical distribution of the
patients by voting district. As is to be expected,
the data show that the farther the patient is from
the capital area, the poorer the medical treatment
he has received.
The second chapter describes the author’s stay in
Germany and his studies there where
stapedectomies were performed with the patient
in a semi-horizontal position and under local
anaesthesia. The chapter presents data to argue
that having the patient in this position makes it
easier for the surgeon to perform the operation
and gives better results that when the patient lies
prone on the operating table.
The next four chapters present the data on the
operations performed in Iceland from 1970-80,
and the audiological results measured at 3 month
intervals for as long as one year from the time of
surgery.
Chapter III covers 296 stapedectomies performed
on 271 patients, 171 of them female and 125 male,
of which 49 were performed in Sweden with the
patients in a semi-horizontal position and the
remaining 247 at the Ear, Nose and Throat
Department of the Reykjavik City Hospital with
the patient lying prone. The audiological results
are presented and compared and conclusions
drawn. In the author’s opinion, otosurgery
performed with the patient in a semi-horizontal
position gives better results: 100% of these cases
had a closed bone-air gap after surgery against
84.6% of those operated on in a prone position.
Of the 296 stapedectomy cases, only 0.3% had
social hearing (0-30 dB) before surgery but 81.1%
at the 1 year follow-up.
Chapter IV covers the 387 tympanoplasties
performed on 323 patients. The medical history
of this method is briefly reviewed along with the
equipment the author used and the type of tissue
used for the implants. The audiological results are
presented in tables, histograms, and the
discussion. The results show that the implant took
in 94% of the cases and the patients obtained
marked hearing improvement at the conclusion of
the surgery.
Chapter V deals with the treatment of chronic
otitis media and the 280 tympanoplasties
performed on 169 patients. The chief aims of the
surgery are, in the first place, to get rid of the
chronic aural discharge, and in the second place
to provide a hearing gain, if it is possible. The
results of these operations are shown in 8 tables
and 4 histograms. One year following surgery
89.4% of the ears were no longer draining and
45% had a marked improvement in hearing.
The sixth chapter is entitled »Disorders of the
External and Middle Ear«. Most of these patients
had an intact tympanic membrane but with a
break in the ossicular chain of varying degree and