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...     

胆脂瘤型和骨疡型中耳炎乳突根治并Ⅰ期鼓室成形术

目的 探讨胆脂瘤型和骨疡型中耳炎乳突根治并Ⅰ期鼓室成形术的术式选择、手术适应证及疗效.方法 回顾性分析78例（78耳）慢性化脓性中耳炎（胆脂瘤型58耳,骨疡型20耳）患者的手术方法及随访1～2年的效果,根据病变范围与程度不同,选择不同术式的乳突根治并Ⅰ期鼓室成形术,保留外耳道后壁乳突切开（完壁式）鼓室成形术28例,切除外耳道后壁乳突切开（开放式）鼓室成形术40例,上鼓室鼓窦开放、上鼓室外侧壁重建鼓室成形术6例,开放式乳突根治外耳道后壁重建鼓室成形术4例.结果 术后2个月干耳率为94.87%（74/78）,语频听力提高≥15dB占73.07%（57/78）,完壁式乳突根治加鼓室成形术后胆脂瘤复发率为14.28%（4/28）,开放式乳突根治加鼓室成形术后鼓膜穿孔率为15.00%（6/40）.结论 根据颞骨CT、听力学检查及临床特征,选择适当手术径路及方式,既可根除病灶,又可行听功能重建,提高干耳率与听力,故乳突根治Ⅰ期行鼓室成形术是有效可行的,但要指出,行完壁式根治伴鼓室成形术要严格掌握适应证,病变要轻并局限在上鼓室,同时要彻底清理胆脂瘤上皮,避免复发.     

慢性化脓性中耳炎患者术前颞骨CT检查对术式选择的意义

目的 探讨慢性化脓性中耳炎患者术前颞骨CT检查在术式选择中的作用.方法 101例慢性化脓性中耳炎患者术前行颞骨HRCT检查,结合听力学及耳内镜检查情况选择不同手术方式,并将术中所见(包括乳突、鼓窦、上鼓室以及听骨链及鼓室粘膜状态)与术前颞骨CT扫描结果比较.结果 101例患者中,39例术前CT显示乳突鼓窦未见密度增高影,均行鼓室成形术,其中术前CT显示听骨病变1例,而术中发现听骨链病变8例,二者符合率为12.5%(1/8);62例术前CT显示鼓窦、乳突腔有低密度影充填,但乳窦气房存在,无骨质吸收及破坏,鼓窦入口无扩大45例,行鼓室成形术,其中4例显示听骨链有病变,28例显示鼓室粘膜增厚,均行鼓室成形术,而术中发现听骨病变15例,鼓室黏膜病变19例,两种病变的术前CT与术中所见的符合率分别为26.67%(4/15)和67.86%(19/28);其余17例术前CT显示鼓室、鼓窦入口、乳突有低密度影充填,且乳窦气房骨质吸收和破坏,鼓室人口扩大,均行乳突根治+鼓室成形术,术前CT与术中所见一致,均可见听骨链及乳突、鼓窦病变.所有患者术后三个月的干耳率为93.07%(94/101),言语频率平均气导听力提高15～18 dB.结论 慢性化脓性中耳炎患者术前颞骨CT检查对听骨链、鼓室粘膜病变的评估的准确性有限,部分患者需要行颞骨高分辨率CT三维重建检查,不能仅凭CT决定术式,应结合听力学检查决定手术方式.     

儿童慢性化脓性中耳炎30耳临床分析

目的探讨儿童慢性化脓性中耳炎的临床特点及治疗方法.方法对我院1990～2004年间住院手术治疗的儿童慢性化脓性中耳炎27例（30耳）进行回顾性分析.3耳行Ⅰ型鼓室成形术,余27耳均行开放式手术,其中22耳行改良乳突根治术（3耳干耳后行Ⅱ期鼓室成形术）,5耳行改良乳突根治加鼓室成形术.结果术后一次性干耳28耳,干耳率为93.3%;单纯行改良乳突根治的19耳中,术后听力提高6耳,不变7耳,下降6耳.Ⅰ期或Ⅱ期行鼓室成形的11耳术后听力均有不同程度的提高.结论儿童慢性化脓性中耳炎宜采用开放式手术,以清除病变,获得干耳.在保证病灶清除前提下可考虑行Ⅰ期或Ⅱ期听力重建.     

耳后肌骨膜瓣在开放式中耳乳突手术中的应用

目的 探讨在开放式中耳乳突手术中应用缩小乳突术相关的耳后肌骨膜瓣效果.方法 总结2005年7月～2007年8月之间,在开放式中耳乳突手术中应用耳后肌骨膜瓣、耳道后壁皮瓣、耳甲腔成形治疗中耳炎患者36例的临床资料,其中,慢性化脓性中耳炎4例;胆脂瘤中耳炎32例;术前500、1 000、2 000 Hz气导平均听阈58.5 dB HL,骨导平均听阈25.5 dB HL;行开放式中耳乳突病变切除加鼓室成形术34例,其中Ⅰ期鼓室成形听骨链重建的患者15例;Ⅱ期鼓室成形术的患者19例;行开放式乳突病变切除术的患者2例.结果 术后全部患者术腔均上皮化,术腔平滑,无死角,乳突腔明显缩小甚至消失,半年后测量外耳道的总容积平均≤1.8 ml.15例时行鼓室成形听骨链重建的患者,术后半年500、1 000、2 000 Hz气导平均听阈28.3 dB HL,骨导平均听阈19.5 dB HL.结论 应用耳后肌骨膜瓣在开放式中耳乳突手术中,缩小术腔维持外耳道的正常生理功能.     

中耳胆固醇肉芽肿

目的 探讨中耳胆固醇肉芽肿的病因、发病机制以及治疗方法。方法 回顾性总结分析我院1988年3月～2003年3月经手术和病理证实的70例(耳)中耳胆固醇肉芽肿病人的临床资料。70例(耳)中，术前诊断为胆脂瘤型中耳炎37例，骨疡型中耳炎13例，此二者之中考虑胆固醇肉芽肿者13例；中耳乳突术后感染5例，分泌性中耳炎7例，特发性血鼓室8例，其中考虑可能为胆固醇肉芽肿者2例。所有病人均有不同程度听力下降、耳闭塞感或伴耳鸣，亦可有耳溢液、头痛、头昏及其他症状。70例(耳)均接受手术治疗，依照术前检查，根据病变程度不同而选择不同术式。结果 65例(耳)干耳，随访1年以上无复发。3例(耳)行改良乳突根治加鼓室成形术，术后半年流脓，后改行乳突根治术，术后均干耳；2例(耳)行鼓室探查加鼓窦开放术，术后半年及1年又流脓伴听力下降，后改行改良乳突根治加鼓室成形术，术后干耳。结论 中耳胆固醇肉芽肿的病因主要有：含气腔通气受阻、引流障碍及含气腔出血。中耳胆固醇肉芽肿与特发性血鼓室、分泌性中耳炎及胆脂瘤关系密切。术式的选择应根据病变范围和程度来决定，其原则是彻底清除病变，保持通畅引流。     

乳突病变切除加鼓室成形术与单纯鼓室成形术治疗中耳炎疗效的Meta分析

目的 比较乳突病变切除加鼓室成形术与单纯鼓室成形术治疗慢性化脓性中耳炎的疗效.方法 通过计算机检索Pubmed、Embase、OVID、Cochrane library、中国知网数据库和万方数据库创建到2015年1月的文献数据,纳入比较乳突病变切除加鼓室成形术与单纯鼓室成形术治疗慢性化脓性中耳炎的随机对照研究和队列研究文献,采用RevMan5.2软件包对纳入文献进行Meta分析,分析两种术式的鼓膜修补愈合率、气导和骨导听阈.结果 共检索到13篇符合纳入标准的文献,其中5篇随机对照研究,8篇队列研究;总患病耳数为2 136耳,行乳突病变切除加鼓室成形术812耳,行单纯鼓室成形术1 324耳.两种手术方式的鼓膜愈合率分别为87.11％ (696/799)和87.55％(1 139/1 301),差异无统计学意义[RR=1.02,95％CI(0.99,1.06),P=0.20];两种术式患者术后气骨导差≤20 dB的耳数分别占79.42％(328/413)和79.17％(475/600),差异无统计学意义[RR=0.99,95％CI(0.93,1.06),P=0.76];两种术式术后气导平均听阈改善差异无统计学意义[SMD=-0.01,95％CI(-0.29,0.31),P=0.93].结论 治疗乳突感染已被良好控制、非活动期但鼓室长期潮湿、中耳黏膜增厚的慢性化脓性中耳炎,乳突病变切除不能提高鼓室成形术后鼓膜愈合率,也不会影响鼓室成形术后听力提高程度.     

中耳胆脂瘤和慢性化脓性中耳炎手术临床分析

目的　探讨中耳胆脂瘤和慢性化脓性中耳炎术式选择及临床效果。方法　对110例中耳乳突病变,包括中耳胆脂瘤和慢性化脓性中耳炎,根据范围显微镜下实施完壁式或开放式乳突根治,部分同时鼓室成形术,随访术后干耳状况、并发症、复发情况以及术后听力改善程度等。结果　110例患者中66例中耳胆脂瘤、44例慢性化脓性中耳炎,出现颅内外并发症者7例。手术方式：51例（46.36%）行完壁式乳突根治术,46例（41.81%）同时行鼓室成形术,59例（53.64%）行开放式乳突根治术。完壁式乳突根治术后听 力提高＞25 dB 37例（33.64%）,＞15 dB 14例（12.72%）;开放式乳突根治术后听力提高＞15 dB 5例（4.55%）,听力减退4例（3.64%）,比较手术前后言语频率区平均听阈,差异有统计学意义（P＜0.05）。术后随访1年发现开放式和完壁式两组胆脂瘤复发共4例。结论　中耳胆脂瘤与慢性化脓性中耳炎通过选择恰当手术方式可获得较好的临床疗效。     

开放性乳突切除术在非胆脂瘤型慢性中耳炎治疗中的作用

在非胆脂瘤型慢性中耳炎的治疗中 ,鼓室成形术是一种安全、疗效良好的手术。但许多因素影响手术的成功 ,包括感染、伤口不愈合、咽鼓管功能障碍、耳内病变遗留 ,手术方法不佳等。本文作者认为 ,缺少开放性乳突切除是鼓室成形术失败的一个重要原因 ,通过重建中耳和乳突之间的联系 ,开放乳突 ,恢复乳突气房对中耳压力的调节功能 ,就可以提高鼓室成形术的手术效果。为此 ,该作者回顾性研究了 135例采用伴开放性乳突切除的鼓室成形修正术的非胆脂瘤性慢性中耳炎病人 ,以判断开放性乳突切除对鼓室成形手术成功率的影响。135例年龄 18～ 77岁 ,男 …     

经耳内镜慢性化脓性中耳炎手术中上鼓室隔分区比较研究

目的通过慢性化脓性中耳炎耳内镜手术中上鼓室隔分区比较研究,探讨以上鼓室隔为界的中耳分区方法对耳内镜下慢性化脓性中耳炎手术的指导意义。方法收集2017年1月至2017年6月于我科就诊的慢性化脓性中耳炎的患者69名(69耳)。所有的患者均进行术前听力学、颞骨HRCT检查,并根据患者术前颞骨HRCT分为中耳腔有阴影组和无阴影组,并对有阴影组的患耳病变区CT值进行测量。所有的患者均在耳内镜下手术。术中分别于以上鼓室隔为界的前下部分和后上部分取0.2×0.2cm2的粘膜标本,术后对收取的粘膜标本进行P物质(SP)免疫组化染色。结果有阴影组和无阴影组术前气骨导差、手术方式、前下部分和后上部分SP表达量均有统计学差异。结论通过对慢性化脓性中耳炎患者的术前颞骨HRCT、耳内镜手术中所见以及对术后不同分区粘膜SP免疫组化的病理学研究发现:以上鼓室隔为界的中耳前下和后上两部分无论是在CT、手术发现还是病理都表现出显著的差异性,为上鼓室隔分区方法在慢性化脓性中耳炎耳内镜手术中的应用提供了一定的指导意义。     

Role of aerating mastoidectomy in noncholesteatomatous chronic otitis media

OBJECTIVE: To assess the success rate of revision tympanoplasty with aerating mastoidectomy in patients with noncholesteatomatous chronic otitis media who had failed at least one prior tympanoplasty. STUDY DESIGN: Retrospective chart review. METHODS: Data were analyzed from 135 patients available for clinical and audiometric studies with a minimum of 18 months' follow-up. All patients had failed at least one prior tympanoplasty and presented with: 1) a persistent tympanic membrane perforation with intermittent drainage, or 2) a wet draining ear, unresponsive to systemic antibiotic and topical management. All patients underwent 1.5-mm, high-density, bone window computed tomography (CT) scanning to assess middle ear, epitympanic, and mastoid air cell pneumatization. All patients underwent revision tympanoplasty with aerating mastoidectomy via a postauricular approach. Patient charts were reviewed for information regarding preoperative radiographic findings, mucosal and ossicular findings at the time of surgery, and success or failure of revision tympanomastoidectomy. RESULTS: The tympanic membrane graft take rate for the entire group of 135 patients was 90.4% (13 grafts failed). A majority of the patients were found to have radiographic and intraoperative evidence of middle ear/mastoid disease. CONCLUSION: For patients with noncholesteatomatous chronic otitis media who have failed prior tympanoplastic reconstruction, an aerating mastoidectomy may be indicated and may improve the success rate of the surgery.     

Tympanoplasty, with or without mastoidectomy, is highly effective for treatment of chronic otitis media in children

CONCLUSION: The overall success rate of tympanoplasty, with or without mastoidectomy, in the treatment of chronic pediatric otitis media, was high and did not depend on patient age, the status of the contralateral ear, the inclusion or absence of surgical mastoidectomy, or the method of mastoidectomy (when this procedure was employed). Tympanoplasty may be expected to improve hearing in cases of chronic otitis media accompanied by perforation, but not in cases of cholesteatoma. OBJECTIVES: This study analyzed the clinical features of pediatric patents with chronic otitis media undergoing tympanoplasty, with or without mastoidectomy. Follow-up data were examined to determine the effectiveness of these procedures on the course of the patients' conditions. SUBJECTS AND METHODS: We retrospectively reviewed the medical records of 111 children (a total of 119 ears were treated from this group) aged 15 years or less, who underwent surgical treatment for pediatric chronic otitis media. The subjects were composed of children suffering from chronic otitis media with perforation (COMP) (63 ears), and patients presenting chronic otitis media with cholesteatoma (COMC) (56 ears). The mean follow-up period was 40 months. Preoperative and postoperative (at the final follow-up) audiometry and otologic examinations were performed. Data from postoperative otologic examinations and audiometric measurements were accompanied by examination of both the operative ear and the contralateral ear. Surgical success was defined as the presence of an intact tympanic membrane without perforation, retraction, or evidence of recurring cholesteatoma. RESULTS: The mean ages at the time of operation were 11.1+/-3.3 years for COMP patients and 9.7+/-3.0 years for COMC subjects. Surgical treatments for pediatric COMP and COMC patients included tympanoplasty only in 45 ears (38% of ears treated) and tympanoplasty with mastoidectomy in 74 ears (62%). Most of patients with COMC received tympanoplasty with mastoidectomy. No patient with COMP underwent canal wall-down mastoidectomy. Mean pre-operative air-bone gaps (ABGs) and post-operative ABGs were compared. Significant improvement in ABG was evident in the COMP group, but not in the COMC group. Surgical success rates at follow-up after 6 months and 12 months were 97% and 95%, respectively, in the COMP group. In the COMC patients, surgical success rates at follow-up after 6 months and 12 months were 98% and 93%. There were no significant relationships between surgical success rate and patient age, the status of the contralateral ear, or the extent of surgery.     

钛质人工听小骨在开放式鼓室成形术中的疗效观察与应用体会

目的 探讨Ⅰ期钛质人工听小骨听力重建在慢性中耳炎和中耳胆脂瘤患者中的临床疗效及应用体会。 方法 回顾性分析行开放式鼓室成形术并接受Ⅰ期钛质人工听小骨听力重建的慢性中耳炎或中耳胆脂瘤患者65例临床资料,比较术前及术后1、3、6个月听力情况和气骨导差(ABG)。 结果 术后第1、3、6个月,纯音气导听阈均值(PTA)较术前降低,差异有统计学意义(P<0.05);术后6个月ABG均值较术前降低,差异具有统计学意义(P<0.05);术后ABG≤20 dB者达39耳(P<0.05)。 结论 开放式鼓室成形术加Ⅰ期钛质人工听小骨行听骨链重建治疗慢性中耳炎和中耳胆脂瘤能够有效提高患者的听力水平;选择适当的手术适应证、良好的手术技巧及围手术期处理是取得成功的保证。     

筋膜外植法鼓室成形术的手术体会

目的 探讨筋膜外植法在鼓室成形术中的应用及价值.方法 回顾分析筋膜外植法鼓室成形术63耳,随访观察患者的外耳道宽敞度、鼓膜形态及听力恢复情况.结果 本组病例包括中耳胆脂瘤25耳,慢性化脓性中耳炎38耳.手术方式分别为筋膜外植法鼓室成形术、筋膜外植法鼓窜成形术+完肇式乳突根治术和筋膜外植法鼓室成形术+开放式乳突根治术三种类型,中耳胆脂瘤和慢性化脓性中耳炎患者实施三种手术的数最分别为4、17、4耳和19、18、1耳.术后切口全部Ⅰ期愈合.随访0.5～3.5年,外耳道宽敞,鼓膜形态良好,听力提高或维持术前水平,未有听力下降者.按时随访者未发现有明显并发症.结论 筋膜外植法鼓室成形术具有操作流程规范、术野暴露充分、病变清除彻底等优点,在慢性中耳炎的外科治疗中具有积极意义.     

Management options for cochlear implantation in patients with chronic otitis media

ObjectivePatients with chronic otitis media with/without cholesteatoma present a significant challenge to safe cochlear implantation (CI). The aim of our study is to describe our experience and propose management options for CI in patients with chronic otitis media.Study designRetrospective case study.SettingTertiary academic center.Subject and methodsWe enrolled the 9 ears of 8 subjects who received CI in the ear with chronic otitis media from 2006 to 2013 by a single surgeon. CI was performed as a single-stage or staged operation with mastoid surgery according to the activity of ear infection.ResultsSix patients had bilateral chronic otitis media and 2 patients had long history of sensorineural hearing loss at contralateral ear. CI was performed with simultaneous radical mastoidectomy with closure of the EAC as a single-stage in 3 ears with a history of previous open cavity mastoidectomy and no active discharge. Staged CI was performed in 6 ears, after radical mastoidectomy with closure of the EAC in 3 ears and after intact canal wall mastoidectomy in 3 ears, due to active inflammation or complications related to otitis media. In one patient, wound infection had occurred, and implant was removed along with implantation at contralateral ear. Other subjects showed no evidence of recurrence.ConclusionDecision whether implantation as a single-stage or staged operation depends on the presence of active inflammation. Single-stage CI with proper mastoid surgery can be performed in patients without active inflammation. Staged procedure need to be done in ears with active inflammation. Proper application of mastoid surgery leads to safe CI for patients with chronic otitis media.     

软壁外耳道重建的鼓室成形术

目的:观察软壁外耳道重建的鼓室成形术治疗胆脂瘤中耳炎的疗效。方法:73例(76耳)胆脂瘤中耳炎患者行开放式乳突病变切除鼓室成形术,以耳后肌骨膜瓣行软壁外耳道重建,不做耳甲腔成形术,应用自体乳突皮质骨或砧骨雕刻后行听骨链重建。观察术后外耳道的形态和功能、术后听力以及有无并发症。结果:本组平均干耳时间为术后(21.1±3.1)d。术后外耳道形态基本正常,保持了正常的功能。随访6～24个月,术后气导听力平均改善(14.5±6.1)dB HL。结论:应用耳后肌骨膜瓣行软壁外耳道重建的鼓室成形术能使外耳道的形态和功能基本恢复正常,无需行耳甲腔成形术,听力改善满意。     

颞骨CT和咽鼓管功能检查对胆脂瘤型中耳炎咽鼓管鼓室口病变的诊断意义

目的：探讨颞骨高分辨率CT（HRCT）和咽鼓管功能检查对胆脂瘤型中耳炎患者术前咽鼓管鼓室口病变的诊断价值。方法：回顾性分析38例（41耳）胆脂瘤型中耳炎患者术前颞骨HRCT扫描和咽鼓管功能综合测试仪检查结果，并与术中显微镜下探查咽鼓管鼓室口处病变情况进行对比分析。结果：颞骨HRCT发现咽鼓管鼓室口软组织占位影34耳；术中发现鼓室口病变32耳，其中为肉芽组织22耳和胆脂瘤4耳，脓团堵塞3耳，鼓室口周围黏膜肥厚肿胀2耳，黏膜粘连闭锁1耳。咽鼓管功能障碍37耳，其中为阻塞型32耳，闭锁不全型5耳。结论：对胆脂瘤型中耳炎患者术前进行颞骨HRCT扫描和咽鼓管功能检查，对术中有目的地处理咽鼓管鼓室口的病变，制定手术方案和预估治疗效果具有重要意义。     

鼓膜紧张部中央性大穿孔患者中耳乳突病变的特点及处理

目的:探讨慢性化脓性中耳炎(单纯型,静止期)伴鼓膜紧张部中央性大穿孔患者的病变特点及处理方法。方法:慢性化脓性中耳炎(单纯型,静止期)伴鼓膜紧张部中央性大穿孔患者147例,其中101例不伴乳突病变者行鼓室成形术;46例伴乳突病变者,在进行鼓室成形术的同时进行乳突开放术。结果:147例中有142例(96.6%)一期愈合。术后3个月纯音听力骨气导差平均为(16.6±10.9)dBHL。结论:慢性化脓性中耳炎(单纯型,静止期)伴鼓膜紧张部大穿孔的患者,术前颞骨高分辨CT检查及术中详细探查是必须的。确保术后咽鼓管、上鼓室、鼓窦,特别是后两者的引流通畅是提高疗效的关键。应用软骨软骨膜复合物行鼓膜重建或上鼓室、后鼓室及鼓膜的联合重建,对鼓膜紧张部中央性大穿孔的患者不失为一种切实可行的治疗方法。     

慢性化脓性中耳炎手术后的早期并发症

目的 :探讨慢性化脓性中耳炎手术后的早期并发症。方法 :2 91例慢性化脓性中耳炎患者 ,行鼓膜成形术 79例 ,鼓室成形术 82例 ,改良乳突根治术 88例 ,乳突根治术 4 2例。结果 :面神经麻痹为 1.0 3% ,骨导中 1个及 1个以上频率阈值升高占 4 .4 7% ,术腔感染为 3.78% ,味觉减退为 2 .4 1% ,短暂的颞颌关节不适为 2 .4 1% ,不平衡感或眩晕为 4 .4 7%。结论 :本组病例手术后的早期并发症发生率与国外报道相似