用声导抗检查外伤性鼓膜穿孔耳的咽鼓管功能

用声导抗检查外伤性鼓膜穿孔耳的咽鼓管功能尹兆富１牟鸿１吴杰１我科自１９９３年８月～１９９５年９月对９６例外伤性鼓膜穿孔患者进行声导抗测试，以观察咽鼓管的功能情况，报告如下。１一般资料９６例中，男６５例，女３１例；左耳６２例，右耳３４例，其中有两例为双...     

重组牛碱性成纤维细胞生长因子治疗慢性鼓膜穿孔的相关机制及临床研究

目的　观察重组牛碱性成纤维细胞生长因子（basic fibroblast growth factor,bFGF）在慢性鼓膜穿孔愈合过程中所起的作用,探讨bFGF的作用机制、疗效及对中耳功能的影响。方法　收集温州医科大学附属第二医院门诊就诊的慢性鼓膜穿孔患者39例,并根据穿孔原因分为慢性外伤性鼓膜穿孔组20例和中耳炎引起的慢性鼓膜穿孔组19例。两组分别根据不同的治疗方法随机再分为2组：第1组为自然愈合对照组,第2组为bFGF治疗组。首诊时,第1组予碘伏清洁患耳外耳道后行耳内镜、纯音听力、声导抗检查,并嘱患者保持外耳道干燥,并定期观察鼓膜愈合情况。第2组先予碘伏清洁患耳后行耳内镜、纯音听力、声导抗检查,予bFGF制剂（贝复舒）滴耳,1次/d,每隔1周以上复诊,观察患耳鼓膜愈合情况及愈合时间,有无并发症等情况。结果  外伤引起的慢性穿孔中,bFGF治疗组、自然愈合对照组比较,在愈合时间上,干预组穿孔完全愈合时间较对照组明显缩短,差异有显著统计学意义（P＜0.01）。在愈合率上,干预组比对照组明显提高,差异有显著统计学意义（P＜0.01）。中耳炎引起的鼓膜穿孔中的bFGF治疗组与保守治疗组比较,bFGF治疗组的愈合率为27.3%,对照组均未愈合,差异无统计学意义（P＞0.05）。结论　单独应用bFGF可明显促进慢性外伤性鼓膜穿孔的愈合,可提高穿孔的愈合率;bFGF亦可缩短慢性外伤性鼓膜穿孔的愈合时间;单独应用bFGF能促进中耳炎引起的慢性鼓膜小穿孔的愈合,对于中等或大穿孔可以缩小穿孔面积;中耳炎引起的慢性鼓膜穿孔联合使用bFGF和明胶海绵可能起到更大的作用效果。     

外伤性鼓膜穿孔棉片贴补后鼓膜生长的动态观察

目的探讨鼓膜穿孔修补术后鼓膜生长愈合的情况。方法对56例(56耳)外伤性中央性鼓膜穿孔患者采取棉片贴补治疗,联合应用耳内镜,每日或隔日更换棉片,对鼓膜生长情况进行动态观察并录像记录,并与43例不用棉片贴补治疗的鼓膜穿孔患者进行比较。结果治疗组鼓膜穿孔愈合率100%,对照组鼓膜穿孔愈合率53.49%(23/43),两组差异有统计学意义(χ2=73.42,P<0.05)。治疗组的鼓膜愈合时间较对照组短。贴补后5天内鼓膜生长较快,中央区愈合慢,边缘区生长快。结论采用棉片贴补治疗外伤性鼓膜穿孔,其贴补物可起"搭桥"作用,促进鼓膜生长。     

鼓膜成形术治疗外伤性鼓膜穿孔的临床意义(附52耳报告)

目的:探讨鼓膜成形术治疗外伤性鼓膜穿孔的临床意义.方法:78例患者(80耳)中男48例,女30例,11～64岁,平均32.4岁,随机分为两组.鼓膜成形术组50例(52耳),鼓膜穿孔后1周内使用素高捷疗眼膏浸渍棉片贴补,对照组保守治疗.结果:鼓膜成形术组鼓膜平均愈合时间11.5d,愈合率为100%,对照组15.4d,愈合率92.8%,差异有显著性(P<0.05).鼓膜成形术组未发生继发感染,对照组6耳继发感染,差异有显著性(P<0.05).结论:鼓膜成形术治疗外伤性鼓膜穿孔可缓解症状,提高听力,减轻患者痛苦,促使鼓膜早期愈合,避免继发感染,操作简便,安全有效.     

外伤性鼓膜穿孔和单纯慢性化脓性中耳炎鼓膜成形术的疗效比较

目的回顾性分析外伤性鼓膜穿孔与单纯型慢性化脓性中耳炎的鼓膜成形术后愈合率及手术前后的听力变化。方法 2008年7月~2011年7月于我科接受首次手术治疗的住院患者,外伤性鼓膜穿孔组19例(20耳),单纯型慢性化脓性中耳炎54例(55耳)。术前及术后三个月随访使用电子耳镜检查鼓膜像,听力评估以500Hz、1000Hz、2000Hz和4000Hz的气骨导差(AirBoneGap,ABG)平均数x-±s表示。结果外伤性鼓膜穿孔的手术愈合率是70.00%(14/20)。单纯型慢性化脓性中耳炎手术愈合率为92.73%(51/55),连续校正的X2=4.74,P<0.05;鼓膜愈合率与年龄、手术方式(外置或内置)以及穿孔大小未见明显相关性。外伤性鼓膜穿孔患者术前平均ABG为17.25±5.81dBHL,单纯型慢性化脓性中耳炎患者术前平均ABG为23.34±9.53dB,两组术前平均听力比较t=2.68,p=0.003。外伤性鼓膜愈合的14例术前平均ABG为17.85±6.15dB,术后为10.58±5.99dB,p=0.005;单纯型慢性化脓性中耳炎组51例鼓膜愈合术前ABG为23.35±9.76dB,术后为14.28±10.53dB,p=0.001,两组术后听力较术前均有明显提高。结论外伤性鼓膜穿孔手术修补成功率较慢性化脓性中耳炎为低。多数外伤性鼓膜穿孔的听力损失较单纯型慢性化脓性中耳炎要轻,而手术成功率更低,需要耳科医生在术前谈话中注意交代手术风险与收益。     

外伤性鼓膜穿孔的法医学鉴定分析

目的 总结外伤性鼓膜穿孔的法医学鉴定规律。方法 回顾性分析308例316耳外伤性鼓膜穿孔法医学鉴定资料。结果 确诊外伤性鼓膜穿孔237耳，穿孔愈合50耳，穿孔合并感染6耳，排除穿孔11耳，8例（耳）排除与所受外伤的关系，3例（耳）无法认定外伤性鼓膜穿孔，1例（耳）诊为慢性化脓性中耳炎。结论外伤性鼓膜穿孔诊断要点为：（1）有耳部或头部受伤史；（2）伴耳痛、耳聋、外耳道少量出血；（3）形态符合外伤性穿孔特点：穿孔多位于紧张部．呈裂隙状、三角形、不规则形等。穿孔边缘锐利、外翻，附有血痂；（4）声导抗检查不能引出鼓室图，或伤耳呈B型曲线但外耳道容积明显大于健耳；（5）排除中耳炎所致穿孔。声导抗和耳内镜检查可以客观真实的反映鼓膜穿孔的形态特征．能为外伤性鼓膜穿孔的法医学鉴定提供客观依据。     

鼓膜微型管置入术治疗中耳不张的临床观察

目的 探讨鼓膜微型管植入术治疗中耳不张的临床疗效.方法 回顾分析26例(28耳)中耳不张的患者,以耳闷为主诉;耳镜检查见鼓膜内陷、光锥散乱或消失、鼓膜苍白无光泽;纯音测听气骨导差＞ 10 dB;声导抗鼓室负压;中耳不张分级Ⅰ～Ⅲ级.患者局麻下行鼓膜微型管置入术,术后随访6 ～12个月.结果 25耳术后耳闷症状消失,其中23耳微型管取出后2周声导抗检查提示鼓室压图由C型恢复为A型,平均听阈下降5 ～20 dB;2耳取管后1个月复发,耳闷症状和中耳负压重新出现.3耳置管失败或耳闷无改善,均为中耳不张Ⅲ级.26例患者取管后2周鼓膜均良好愈合,未出现感染、鼓膜穿孔等并发症.结论 鼓膜微型管置入术能有效解除鼓室负压,缓解耳闷,可用于Ⅰ～Ⅱ级中耳不张的治疗.     

宣纸贴补治疗外伤性鼓膜穿孔(附36例报告)

外伤性鼓膜穿孔后,为促进鼓膜尽快自行修复,1996年至1998年我院采用宣纸涂红霉素眼膏贴补鼓膜治疗外伤性鼓膜穿孔36例.现报告如下.     

Ⅰ型鼓室成形术中咽鼓管功能的评估及其对疗效的影响

目的通过对采用Ⅰ型鼓室成形术治疗慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)患者的临床资料进行分析,探讨咽鼓管功能及其评估对其疗效的影响。方法分析64例(64耳)采用I型鼓室成形术治疗CSOM的患者资料,根据咽鼓管功能检测(ETS)结果分为咽鼓管功能障碍组及咽鼓管功能正常组。观察声导抗正-负压平衡法与ETS两种检测方法的一致率及两组患者术前及术后的气导听阈值变化、气骨导差值变化、鼓膜愈合、听力改善、干耳时间和并发症等指标情况。结果声导抗正-负平衡法与ETS两种检测方法一致率为76.56%,咽鼓管功能正常组和咽鼓管功能障碍组患者术后的气导听阈值和气骨导差均低于术前(P<0.05),两组在术前及术后(3个月、6个月)的气导听阈值、气骨导差及其差值变化,听力改善率、干耳时间等指标差异有统计学意义(P<0.05);而两组患者在的鼓膜愈合率、术后干耳率及术后并发症发生率差异均无统计学意义(P>0.05)。结论声导抗正负压平衡法结合ETS检测法对鼓膜穿孔患者进行主客观咽鼓管功能检测,可提高咽鼓管功能检测的准确率,可作为咽鼓管功能检测的补充手段。     

鼓膜微型管置入术治疗中耳不张32例

目的 探讨鼓膜微管置入术治疗中耳不张的手术方法和临床疗效.方法 回顾分析32例(34耳)中耳不张的患者病历资料.选择耳闷就诊患者,进行耳镜、听力和鼓室导抗检查,并在局麻或全麻下行鼓膜微管置入术,术后随访2～6个月.结果 置管成功34耳,术后耳闷症状消除30耳,声导抗提示鼓室图由“C”型恢复为“A”型,纯音听阈测试提示听力提高5～15 dB.没有患者出现感染、鼓膜穿孔和鼓室硬化等并发症.结论 鼓膜微管置入术治疗中耳不张,不需鼓膜切开,损伤小,效果显著,具有临床应用价值.     

The effect of epidermal growth factor on the pseudo-healing of traumatic tympanic membrane perforations

IntroductionTraumatic tympanic membrane perforations tend to heal spontaneously. However, in this study, several perforations exhibited abnormal healing, where the morphology of healing tympanic membranes differed from that of non-perforated tympanic membranes. Pseudo-healing of the tympanic membrane was characterized by the accumulation of thickened tissue in the perforated area.ObjectiveThe purpose of this study was to evaluate the utility of epidermal growth factor in cases showing pseudo-healing of traumatic tympanic membrane perforations.MethodsA total of 26 traumatic tympanic membrane perforations showing pseudo-healing were included in this study. In all cases, tissue that accumulated in the perforated area was removed, which subsequently caused a new perforation to form. An epidermal growth factor solution was applied to the tympanic membrane once daily to keep the tympanic membrane moist. Closure rates and times were evaluated at 6 months.ResultsDuring the 6 months follow-up period, two patients were lost. Of the remaining 24 patients, the closure rate was 100% (24/24) and the closure time was 6.1 ± 2.3 days (range: 3–12 days). The morphology of the healed tympanic membrane was not significantly different from that of the remnant tympanic membrane.ConclusionsPseudo-healing of traumatic tympanic membrane perforations affects sound conduction. This can be associated with various symptoms, including tinnitus, aural fullness, and ear discomfort. The excision of excessive epithelial tissue and topical application of epidermal growth factor can correct the pseudo-healing of traumatic tympanic membrane perforations.     

创伤性鼓膜穿孔的治疗及其研究进展

目的创伤性鼓膜穿孔是耳鼻咽喉科门急诊中常见的疾病之一。对于创伤性鼓膜穿孔的治疗有多种方法可供选择，但是目前国内外尚无统一的标准。创伤性鼓膜穿孔自然愈合机制比较复杂，影响其愈合及预后的因素较多，不合理的治疗会给患者带来不良的影响。本文介绍了创伤性鼓膜穿孔的自然愈合情况，以及汇总近年国内外关于创伤性鼓膜穿孔的治疗及研究进展，并予以综述，旨在为创伤性鼓膜穿孔的临床治疗方法的选择和研究提供参考。     

Spontaneous healing of the tympanic membrane after traumatic perforation in rats

The most common etiologies of tympanic membrane perforation are infections and trauma.ObjectiveThe objective of the present study was to assess the healing of traumatic tympanic membrane perforation in rats.MethodsThe tympanic membrane from male Wistar rats was perforated in the anterior and posterior portions to the handle of the malleus. Five tympanic membranes were evaluated 3 days after tympanic perforation; 5 after 5 days; 5 after 7 days; 3 after 10 days; and 4 after 14 days. The tympanic membranes were submitted to histopathological evaluation after hematoxylin–eosin staining.ResultsTympanic membrane closure occurred at about 7–10 days after injury and the healing process was complete by day 14. The proliferative activity of the outer epithelial layer was present close to the handle of the malleus and to the tympanic annulus.ConclusionThe spontaneous healing process of the tympanic membrane starts from the outer epithelial layer, with later healing of the lamina propria and the mucosal layer.     

重组表皮生长因子治疗外伤性鼓膜穿孔的临床观察

目的观察重组人表皮生长因子(reconstruct humar epidermic growth factor,rhEGF)明胶海绵贴补治疗外伤性鼓膜穿孔的疗效。方法rhEGF治疗外伤性鼓膜穿孔68例,按随机分组为治疗组37例,对照组31例。结果rhEGF治疗外伤性鼓膜穿孔,依穿孔部位及形态分为前下、下半、后半和后下4组,治疗组较对照组愈合时间(4周内),分别提前7．5,7．6,12．2,12.6天,未见明显不良反应。结论rhEGF贴补治疗可有效地促进外伤性鼓膜穿孔愈合,缩短愈合时间。     

Chronic tympanic membrane perforation in an animal model

Objective

The aim of this study was to revalidate and reproduce a chronic tympanic membrane perforation animal model.

Study design

Prospective, animal study.

Methods

Eight female chinchillas underwent bilateral thermal myringotomy. The edges of the perforation were folded inward using microflaps. The perforations were followed over time to monitor the course of closure.

Results

Two animals were excluded from the study because of ear infection. None of the other tympanic membrane perforations remained open. The closing time varied from 4 to 6 weeks.

Conclusions

Our findings demonstrate that the thermal myringotomy combined with infolding technique is not a reliable and consistent method to create a chronic tympanic membrane perforation. The closing time is shorter than expected and varies among the study subjects.There is a clear need for developing a reliable chronic tympanic membrane perforation model.     

Histologic changes of mesenchymal stem cell repair of tympanic membrane perforation

Abstract

Conclusion: Mesenchymal stem-cells are good candidates for cell-therapy of chronic tympanic membranes perforations.

Objectives: To determine the effects of cell-based therapy in tympanic membrane perforations.

Methods: Young C57BL/6 mice were anesthetized with intraperitoneal administration of ketamine and xylazine and randomly divided into three groups (n?=?4 ears/group) that underwent bilateral sub-total pars tensa perforations of equal sizes using a sterile 27-gauge needle under a surgical microscope. Six-to-eight hours after injury, one group of mice did not receive treatment (acute perforation control), and the last two groups were treated with BM-MSCs embedded within HA scaffolds previously soaked in PBS to rinse culture media residues to avoid confounders and were euthanized 1 or 2 weeks after treatment.

Results: Untreated tympanic membrane perforations developed a hyper-cellular infiltrate surrounding the injury site, while BM-MSC treated eardrums showed a reduced inflammatory response after the first week and a restoration of the trilaminar configuration 2 weeks after treatment, mimicking a normal tympanic membrane.     

软骨栅-软骨膜鼓膜成形术

目的探讨用自体软骨栅-软骨膜行鼓室成形术的疗效。方法用自体条栅状软骨行鼓室成形术对66耳鼓膜穿孔（面积>50%）的患者进行鼓膜修补,并与同期用颞肌筋膜修补的60耳相同病变进行比较。结果软骨-软骨膜组的近期鼓膜穿孔愈合率为92.4%,颞肌筋膜组为80%。两组的听力结果差异无显著性。结论软骨-软骨膜特别适用于修补鼓膜大穿孔及粘连性中耳炎。条栅状软骨-软骨膜鼓膜成形术是一种很好的修补鼓膜大穿孔的方法。     

Repair of large traumatic tympanic membrane perforation using ofloxacin otic solution and gelatin sponge

IntroductionTraumatic large tympanic membrane perforations usually fail to heal and require longer healing times. Few studies have compared the healing and hearing outcomes between gelatin sponge patching and ofloxacin otic solution.ObjectivesTo compare the healing outcomes of large traumatic tympanic membrane perforations treated with gelatin sponge, ofloxacin otic solution, and spontaneous healing.MethodsTraumatic tympanic membrane perforations >50% of the entire eardrum were randomly divided into three groups: ofloxacin otic solution, gelatin sponge patch and spontaneous healing groups. The healing outcome and hearing gain were compared between the three groups at 6 months.ResultsA total of 136 patients with large traumatic tympanic membrane perforations were included in analyses. The closure rates were 97.6% (40/41), 87.2% (41/47), and 79.2% (38/48) in the ofloxacin otic solution, gelatin sponge patch, and spontaneous healing groups, respectively (p = 0.041). The mean times to closure were 13.12 ± 4.61, 16.47 ± 6.24, and 49.51 ± 18.22 days in these groups, respectively (p < 0.001).ConclusionsGelatin sponge patch and ofloxacin otic solution may serve as effective and inexpensive treatment strategies for traumatic large tympanic membrane perforations. However, ofloxacin otic solution must be self-applied daily to keep the perforation edge moist, while gelatin sponge patching requires periodic removal and re-patching.     

A new method for closing tympanic membrane perforations using basic fibroblast growth factor

OBJECTIVE: To present a new method for closing tympanic membrane perforations using basic fibroblast growth factor (bFGF) combined with an atelocollagen/silicone bilayer membrane as a patch material. STUDY DESIGN: Closure of tympanic membrane perforations was attempted using bFGF, which is thought to facilitate the growth of fibroblasts and collagen fibers at the margin of the perforation. METHODS: Under an operating microscope, the margin of the perforation was trimmed, and a piece of an atelocollagen/silicone bilayer membrane infiltrated with 0.2 mL Trafermin (0.1% solution) (bFGF group) or saline (control group) was then placed in the perforation with the silicon layer facing outward. Nine patients were treated with bFGF, and five were treated with saline. Data obtained from patient records included patient age, perforation size, and duration of treatment, with a focus on hearing improvement and complete tympanic membrane closure. RESULTS: The mean perforation size before treatment was 16.5% in the bFGF group and 9.6% in the control group. Closure of the tympanic membrane perforation was achieved in all cases in the bFGF group, whereas it was achieved in only two of five cases in the control group. With bFGF treatment, the tympanic membrane perforations closed completely within 3.7 weeks, and hearing improved by 13.3 dB in the bFGF group. CONCLUSION: The study demonstrated that bFGF combined with an atelocollagen/silicone bilayer membrane is effective for the conservative treatment of tympanic membrane perforation.     

耳内镜下异体真皮基质修补鼓膜大穿孔

目的探讨耳内镜下用异体真皮基质修补鼓膜大穿孔的可行性及效果。方法回顾性分析45例鼓膜大穿孔患者的临床资料,患者术前分别行耳内镜检查、听力学检查,有中耳感染史者行CT检查。其中术前电测听语言频率平均气骨导间距(ABG)为(31.23±1.52)dB。45例患者均在耳内镜下经外耳道径路翻起外耳道鼓膜皮瓣,用异体真皮基质内植修补鼓膜。结果术后随访6个月至2年,术后3个月时一次性穿孔愈合率91％。术后3个月复查电测听,平均ABG为(13.07±2.00)dB,与术前比较差异具有统计学意义(t=8.09, P<0.00)。结论耳内镜下异体真皮基质内植修补鼓膜大穿孔,具有微创,体表无切口,愈合率高等特点。