粘连性中耳炎的手术治疗

目的　探讨治疗粘连性中耳炎的手术适应证及手术方法。方法　对 6 9例 (6 9耳 )粘连性中耳炎患者进行了手术治疗。术后能够随访 1年以上的 4 1例。术前平均 ( x±s,以下同 )骨气导差(2 5 0、5 0 0、10 0 0、2 0 0 0Hz ,4 3 8± 3 9)dB。术中切除粘连的鼓膜以及瘢痕组织 ,进行听骨链重建 ,并用耳屏软骨修补鼓膜穿孔。结果　术后 1个月平均骨气导差为 (2 3 7± 8 6 )dB。 4 1耳术后 1年平均骨气导差为 (2 7 9± 10 7)dB。长期随访组中共有 18耳 (43 9% )术后骨气导差 <2 0dB。有 2 6耳术后听力提高 >15dB。耳显微镜观察鼓膜及中耳 ,术后 2 4耳 (5 8 5 % )的鼓室接近正常。结论　粘连性中耳炎可以进行手术治疗 ,但必须仔细选择手术适应证。用软骨重建鼓膜是治疗粘连的好方法。     

耳廓软骨在修补鼓膜和重建外耳道后壁中的应用

目的：探讨应用耳廓软骨修补鼓膜并同时进行外耳道后壁重建的疗效。方法：对43耳慢性化脓性中耳炎患者，于彻底清除病灶后用耳廓软骨行鼓膜修补，同时进行外耳道后壁重建。结果 ：43耳中，3耳失败，40耳一期愈合。与同期未进行外耳道后壁重建，只进行鼓室成形的病例相比，外耳道后壁重建者的干耳的时间比未重建者短；复发率差异无显著性意义。两组术后均有较好的听力。结论：应用耳廓软骨同时修补鼓膜并重建外耳道后壁，是一种较好的治疗慢性化脓性中耳炎的方法，不公能缩短时间，改善听力，而且免除了二次手术，明显改善了患者的生活质量。     

改良乳突根治术后外耳道后壁重建与鼓室成形

目的 探讨改良乳突根治术后外耳道后壁重建与鼓室成形的可行性.方法 37例(37耳)已行改良乳突根治术且听力为传导聋的患者,采用耳甲腔或耳甲艇软骨和带血管蒂的颞肌筋膜瓣重建外耳道后壁,同期耳屏软骨软骨膜复合物连同听骨链重建鼓室成形.结果 37耳均获得接近正常解剖生理的外耳道,术后3～4周干耳,用耳屏软骨软骨膜复合物修补的鼓膜愈合佳,形态正常.行听力重建的32耳术后听力骨气导差较术前平均缩小了27 dB(500、1000、2000、4000 kz的均值).其中获得完整资料的病例有27耳,随访1～3年,听力结果 稳定.结论对镫骨底板未固定、鼓室未上皮化、耳咽管功能良好的改良乳突根治术后患者,手术重建外耳道后壁及鼓室成形可获得较好的临床效果.     

改良乳突根治术后外耳道后壁重建与鼓室成形

目的 探讨改良乳突根治术后外耳道后壁重建与鼓室成形的可行性.方法 37例(37耳)已行改良乳突根治术且听力为传导聋的患者,采用耳甲腔或耳甲艇软骨和带血管蒂的颞肌筋膜瓣重建外耳道后壁,同期耳屏软骨软骨膜复合物连同听骨链重建鼓室成形.结果 37耳均获得接近正常解剖生理的外耳道,术后3～4周干耳,用耳屏软骨软骨膜复合物修补的鼓膜愈合佳,形态正常.行听力重建的32耳术后听力骨气导差较术前平均缩小了27 dB(500、1000、2000、4000 kz的均值).其中获得完整资料的病例有27耳,随访1～3年,听力结果 稳定.结论对镫骨底板未固定、鼓室未上皮化、耳咽管功能良好的改良乳突根治术后患者,手术重建外耳道后壁及鼓室成形可获得较好的临床效果.     

改良乳突根治术后外耳道后壁重建与鼓室成形

目的 探讨改良乳突根治术后外耳道后壁重建与鼓室成形的可行性.方法 37例(37耳)已行改良乳突根治术且听力为传导聋的患者,采用耳甲腔或耳甲艇软骨和带血管蒂的颞肌筋膜瓣重建外耳道后壁,同期耳屏软骨软骨膜复合物连同听骨链重建鼓室成形.结果 37耳均获得接近正常解剖生理的外耳道,术后3～4周干耳,用耳屏软骨软骨膜复合物修补的鼓膜愈合佳,形态正常.行听力重建的32耳术后听力骨气导差较术前平均缩小了27 dB(500、1000、2000、4000 kz的均值).其中获得完整资料的病例有27耳,随访1～3年,听力结果 稳定.结论对镫骨底板未固定、鼓室未上皮化、耳咽管功能良好的改良乳突根治术后患者,手术重建外耳道后壁及鼓室成形可获得较好的临床效果.     

改良乳突根治术后外耳道后壁重建与鼓室成形

目的 探讨改良乳突根治术后外耳道后壁重建与鼓室成形的可行性.方法 37例(37耳)已行改良乳突根治术且听力为传导聋的患者,采用耳甲腔或耳甲艇软骨和带血管蒂的颞肌筋膜瓣重建外耳道后壁,同期耳屏软骨软骨膜复合物连同听骨链重建鼓室成形.结果 37耳均获得接近正常解剖生理的外耳道,术后3～4周干耳,用耳屏软骨软骨膜复合物修补的鼓膜愈合佳,形态正常.行听力重建的32耳术后听力骨气导差较术前平均缩小了27 dB(500、1000、2000、4000 kz的均值).其中获得完整资料的病例有27耳,随访1～3年,听力结果 稳定.结论对镫骨底板未固定、鼓室未上皮化、耳咽管功能良好的改良乳突根治术后患者,手术重建外耳道后壁及鼓室成形可获得较好的临床效果.     

改良乳突根治术后外耳道后壁重建与鼓室成形

目的 探讨改良乳突根治术后外耳道后壁重建与鼓室成形的可行性.方法 37例(37耳)已行改良乳突根治术且听力为传导聋的患者,采用耳甲腔或耳甲艇软骨和带血管蒂的颞肌筋膜瓣重建外耳道后壁,同期耳屏软骨软骨膜复合物连同听骨链重建鼓室成形.结果 37耳均获得接近正常解剖生理的外耳道,术后3～4周干耳,用耳屏软骨软骨膜复合物修补的鼓膜愈合佳,形态正常.行听力重建的32耳术后听力骨气导差较术前平均缩小了27 dB(500、1000、2000、4000 kz的均值).其中获得完整资料的病例有27耳,随访1～3年,听力结果 稳定.结论对镫骨底板未固定、鼓室未上皮化、耳咽管功能良好的改良乳突根治术后患者,手术重建外耳道后壁及鼓室成形可获得较好的临床效果.     

改良乳突根治术后外耳道后壁重建与鼓室成形

目的 探讨改良乳突根治术后外耳道后壁重建与鼓室成形的可行性.方法 37例(37耳)已行改良乳突根治术且听力为传导聋的患者,采用耳甲腔或耳甲艇软骨和带血管蒂的颞肌筋膜瓣重建外耳道后壁,同期耳屏软骨软骨膜复合物连同听骨链重建鼓室成形.结果 37耳均获得接近正常解剖生理的外耳道,术后3～4周干耳,用耳屏软骨软骨膜复合物修补的鼓膜愈合佳,形态正常.行听力重建的32耳术后听力骨气导差较术前平均缩小了27 dB(500、1000、2000、4000 kz的均值).其中获得完整资料的病例有27耳,随访1～3年,听力结果 稳定.结论对镫骨底板未固定、鼓室未上皮化、耳咽管功能良好的改良乳突根治术后患者,手术重建外耳道后壁及鼓室成形可获得较好的临床效果.     

带蒂颞肌筋膜重建外耳道后壁及鼓室成形术

目的探讨采用带蒂颞肌筋膜重建外耳道后壁及鼓室成形术治疗胆脂瘤中耳炎的初步临床疗效。方法选择74例胆脂瘤中耳炎,在改良乳突根治的基础上,39耳以带蒂颞肌筋膜蒂部重建外耳道后壁、筋膜部修补鼓膜,为重建组;35耳以游离颞肌筋膜修补鼓膜,为开放组。比较两组术后疗效。结果术后随访2～4年,重建组随访37例,外耳道接近正常,筋膜成活率97.29%,复发率5.6%。开放组随访33例,外耳道宽大畸形,筋膜成活率93.93%,复发率6.3%。两组手术前、后语频区(0.5、1、2、4 kHz)骨气导差缩小值,重建组分别为(15.3±0.33)、(15.1±0.30)、(15.6±0.25)、(20.5±1.34)dB;开放组分别为(13.8±0.36)、(13.5±0.43)、(13.4±0.42)、(14.6±0.76)dB,差异有统计学意义。结论耳后带蒂颞肌筋膜重建外耳道后壁及鼓室成形术治疗胆脂瘤中耳炎,术后干耳时间短,外耳道接近正常,修补物成活率高,术后骨气导差缩小显著,复发率低。     

改良乳突根治术后外耳道后壁重建与鼓室成形

目的 探讨改良乳突根治术后外耳道后壁重建与鼓室成形的可行性.方法 37例(37耳)已行改良乳突根治术且听力为传导聋的患者,采用耳甲腔或耳甲艇软骨和带血管蒂的颞肌筋膜瓣重建外耳道后壁,同期耳屏软骨软骨膜复合物连同听骨链重建鼓室成形.结果 37耳均获得接近正常解剖生理的外耳道,术后3～4周干耳,用耳屏软骨软骨膜复合物修补的鼓膜愈合佳,形态正常.行听力重建的32耳术后听力骨气导差较术前平均缩小了27 dB(500、1000、2000、4000 kz的均值).其中获得完整资料的病例有27耳,随访1～3年,听力结果 稳定.结论对镫骨底板未固定、鼓室未上皮化、耳咽管功能良好的改良乳突根治术后患者,手术重建外耳道后壁及鼓室成形可获得较好的临床效果.     

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豉室成形术对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。     

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。     

保持外耳道后壁完整的上鼓室切开软骨重建技术在中耳炎手术中的应用

目的观察在保持外耳道后壁完整的情况下，上鼓室切开软骨重建技术在中耳炎手术中的应用及疗效。方法对45例（耳）中耳胆脂瘤和13例（耳）活动期中耳炎患者，在保留外耳道后壁乳突切开、上鼓室外侧壁切除或及经砧骨窝向下开放面隐窝，清除听骨链区（包括上鼓室、中后鼓室）及鼓窦乳突区病变后，行上鼓室软骨封闭重建术，术后随访12～36个月，观察术后中耳炎胆脂瘤复发、鼓膜形态及听力提高等情况。结果58例（耳）术后重建的上鼓室外侧壁与保留的外耳道后壁相连接。本组病例中6例术后外耳道后壁肿胀或皮肤缺损，继续换药4~5次后愈合良好；3例患者出院后仍有少量流脓，鼓膜边缘穿孔，门诊局部给药后延迟愈合；3例听骨脱出、2例鼓膜再穿孔、2例24个月后原胆脂瘤复发，行开放式手术后治愈。术后6个月复查纯音听力测试，并与术前进行比较，听力均有不同程度提高，0.5、1、2 kHz气骨导差平均减10 dB，气导听阈平均提高15 dB 左右。结论在保持外耳道后壁完整的情况下，上鼓室切开软骨重建技术在中耳炎外科手术中的应用，既能够充分暴露病变，病灶清除彻底，同时又保留了外耳道的形态，可有效防止鼓膜回缩袋的形成，降低了胆脂瘤的复发，又避免了开放式手术所残留的宽大术腔。术后鼓膜形态恢复良好，从而保持或提高了患者的听力。     

保留乳突的改良完壁式鼓室成形术的临床疗效观察

目的 探讨局限于上鼓室区病变的慢性化脓性中耳炎、中耳胆脂瘤行上鼓室径路保留乳突的改良完壁式鼓室成形术的长期临床疗效.方法 诊断慢性化脓性中耳炎、中耳胆脂瘤47例(47耳)患者,结合患者专科检查,依据手术方式不同分A、B两组,A组行上鼓室径路保留乳突的改良完壁式鼓室成形术,B组行完壁式乳突切开+鼓室成形术.术后随访5～7...     

Evaluation of canal wall down tympanoplasty with canal reconstruction for draining ear with middle ear cholesteatoma

OBJECTIVES: We studied the postoperative stability of canal wall down tympanoplasty with canal reconstruction for middle ear cholesteatoma with preoperative otorrhea. SUBJECTS AND METHODS: 155 ears with middle ear cholesteatoma treated with canal wall down tympanoplasty with canal reconstruction were evaluated retrospectively. A comparison was made between the group of 80 ears which showed otorrhea, preoperatively, and the group of 75 without preoperative otorrhea. Problems observed in the tympanic membrane or reconstructed external auditory canal were evaluated both at the postoperative initial stage and more than 1 year after surgery. Postoperative hearing prognosis was also studied. RESULTS: 1) In the postoperative initial stage, local infection and necrosis of materials for canal reconstruction were significantly more likely to be observed in ears with preoperative otorrhea. 2) In ears with postoperative local infection, necrosis of materials for canal reconstruction occurred more frequently, and the period until drying of the reconstructed external auditory canal was significantly extended. 3) No significant difference was seen in postoperative status of the tympanic membrane and reconstructed ear canal at least 1 year after surgery. 4) The presence of preoperative otorrhea had no influence on hearing prognosis. CONCLUSIONS: When canal wall down tympanoplasty with canal reconstruction is used for ears with preoperative otorrhea, careful attention should be paid to local treatment at the postoperative initial stage. However, no significant problem occurred in the outcome of preoperative ear draining at least 1 year after surgery.     

前壁外耳道-鼓膜瓣应用于开放式鼓室成形术31例

目的 探讨前壁外耳道-鼓膜瓣应用于开放式鼓室成形术中,能否提高鼓膜修补成功率和手术疗效.方法 对慢性化脓性中耳炎及中耳胆脂瘤伴中、下鼓室自行封闭患者66例(66耳),予开放式鼓室成形术治疗,其中31例术中应用前壁外耳道-鼓膜瓣内植法鼓室成形(前瓣组),35例应用软骨和筋膜内植法鼓室成形(软骨组),测定术前及术后6个月气导(AC)、气骨导差(ABG),比较两组的临床疗效.结果 前瓣组成功率为96.8%(30/31),软骨组88.6%(31/35),两组比较差异无统计学意义(P>0.05);前瓣组有效率为88.46%,软骨组为65.52%,两组比较差异有统计学意义(P<0.05),即前瓣组优于软骨组.结论 伴有中、下鼓室封闭的慢性中耳炎患者,行开放式鼓室成形术中应用前壁外耳道-鼓膜瓣鼓室成形能提高筋膜成活率,术后鼓膜穿孔率低,较好成形鼓室,并能同期听力重建,提高听力.     

Cartilage perichondrium composite graft (CPCG) in pediatric tympanoplasty

Different policies on the treatment of tympanic membrane perforation in the pediatric age group continue to exist. Thirty patients were included in this study over a period of 2 years, where cartilage perichondrium composite graft (CPCG) was used to close the tympanic membrane perforation. Successful drum closure was achieved in 86.6% of cases, regardless of the site of perforation or the status of the operated ear. The graft was taken from the tragus and was placed in an underlay fashion with cartilage towards the promontory and the perichondrium immediately to the tympanic membrane remnants. The postoperative hearing gain although delayed up to 6 months was excellent either subjective or objective. So, CPCG has proved advantageous as a graft material to close perforation in the tympanic membrane in pediatric age group.     

Malleus removal and total cartilage reinforcement in intact canal wall tympanoplasty for cholesteatoma

This study analyzes the morphological and hearing results obtained from intact canal wall cholesteatoma surgery by removing the malleus, reinforcing the whole tympanic membrane with cartilage, and performing an ossiculoplasty with a hydroxyapatite prosthesis. The results were compared to those obtained in intact canal wall cholesteatoma surgery by preserving the malleus manubrium, partially reinforcing the tympanic membrane with cartilage, and predominantly using an ossicle to perform the ossiculoplasty. One- or two-stage intact canal wall procedures were performed in 390 adult patients (416 ears) who had a nonoperated middle ear cholesteatoma. Recurrent and residual cholesteatoma rates were evaluated. Hearing results were analyzed according to the Committee on Hearing and Equilibrium Guidelines of the American Academy of Otolaryngology-Head and Neck Surgery. There was a statistically significant decrease in the recurrence rate in patients who had total cartilage reinforcement of the tympanic membrane versus patients who had partial tympanic membrane cartilage reinforcement. This technique using a hydroxyapatite prosthesis for ossiculoplasty gave good hearing results.     

Combined reconstruction of congenital auricular atresia and severe microtia

OBJECTIVES: Due to their embryologic developments, auricular atresia and severe microtia are in most cases combined malformations. The aims of this study were to develop a surgical technique for combined esthetic and functional reconstruction with a minimum of operations and to evaluate the results. STUDY DESIGN: Prospective clinical evaluation. PATIENTS AND METHODS: Fifty-two patients with third-degree microtia and congenital aural atresia with a sound-conducting block of about 50 dB were treated as described here. In the first operation, autogenous cartilage is harvested and the auricular framework fabricated and implanted. In addition, the tympanic membrane and the external ear canal are prefabricated and stored in a subcutaneous pocket. In the second step, the elevation of the new framework is combined with the operation for atresia utilizing the prefabricated tympanic membrane and external ear canal. In the third step, the cavum conchae is deepened and the external ear canal opened and covered with a skin graft. RESULTS: Seventy-six percent of the patients had a final conducting hearing loss of 30 dB or less. No restenosis of the new external ear canal was observed. The esthetic results of the constructed auricles are shown. CONCLUSION: With this combination of plastic surgery for the auricle and functional surgery for the middle ear, no additional operations are necessary, and the prefabrication of the external ear canal and the tympanic membrane gives stable and reliable results. Therefore, we think that this combined technique offers the best chance for an optimal esthetic and functional rehabilitation of patients with these malformations.