Results of endoscopic cartilage tympanoplasty procedure with limited tympanomeatal flap incision

Objective: The aim of this study was to evaluate the outcomes of this minimally invasive tympanomeatal incision technique performed during endoscopic transcanal cartilage tympanoplasty.

Study design: Prospective clinical study.

Methods: Eighty-seven patients (87 ears) who had TM perforation with noncomplicated COM were included. All of the patients were operated with the endoscopic transcanal cartilage tympanoplasty technique. All of the data were prospectively collected. These included demographic data, date of the surgery, preoperative and postoperative pure-tone audiometry (PTA), localization of TM perforation and graft healing success.

Results: Mean follow-up time was 14.76?±?4.32 months. Graft-healing rate was 100%. Mean air bone gap level improvement (dB HL) at 0.5, 1, 2 and 4?kHz were 13.87?±?7.30?dB HL, 9.09?±?7.59?dB HL, 9.74?±?6.40?dB HL and 7.46?±?6.37?dB HL, respectively. At all frequencies, there was significant difference between pre and postoperative mean air bone gap levels (p?p?>?.05).

Conclusions: Endoscopic ear surgery has successful surgical outcomes with low complication rates. In this study, the outcomes of limited tympanomeatal flap incision was discussed. It is suggested that this technique is reliable with good hearing results with low postoperative complications rates.     

Comparison of anterior and posterior tympanomeatal flap elevations in endoscopic transcanal tympanoplasty

Background: There is not an ideal tympanomeatal flap incision type for transcanal procedures.

Aims/Objectives: Comparing the outcomes and feasibility of posteriorly and anteriorly based tympanomeatal flap incisions for anterior perforations in endoscopic transcanal cartilage tympanoplasty.

Material and methods: Twenty-six patients who had anterior TM perforation were included. Patients were divided into two groups with randomization. All of the data were prospectively collected. These included demographic data, date of the surgery, mean surgery time, preoperative and postoperative sixth-month pure-tone audiometry (PTA), type of tympanomeatal flap incision and graft healing success.

Results: Mean follow up time was 20.69?±?5.03 months. Graft healing rate was 100% in both groups. There was no major complication in both of groups. Mean air bone gap level improvement of (dB HL) at all frequencies was 7.69?±?2.83?dB HL in group 1 and 7.98?±?3.08?dB HL in group 2 respectively. Regarding pre-and postoperative mean air bone gap levels and mean surgery times, there was no significant difference between groups (p>.05).

Conclusions and significance: For non-complicated anterior perforations that are less than 50% of TM, endoscopic transcanal cartilage tympanoplasty using anterior tympanomeatal flap elevation procedure was seemed minimally invasive and feasible to perform with successful audiologic and postoperative outcomes.     

Endoscopic butterfly inlay myringoplasty: new technique extended perichondrium butterfly

Abstract

Background: Various graft materials and surgical methods are used in the treatment of tympanic membrane perforations.

Aims/Objectives: The aim of this study was to evaluate the operation method and graft success of extended perichondrial butterfly myringoplasty performed by an endoscopic method and the hearing gain of patients.

Material and Method: This was a retrospective study evaluating the hearing tests of 54 ears of 48 patients (28 male, 20 female) who underwent surgery between February 2017 and March 2019. Pure-tone audiometric results were analyzed preoperatively and six months postoperatively by recording the perforation size, the duration of surgery, and graft success.

Results: The graft success rate was 98.1% (53/54 ears). The perforations were most frequently located in the anterior quadrant and were small-sized. The mean preoperative air-bone gap (ABG) was 17.4?±?5.24?dB. The mean ABG was 9.2?±?2.13?dB 1 month postoperatively and 8.5?±?2.26?dB 6 months postoperatively (p?<?.005).

Conclusions: The endoscopic inlay extended perichondrial butterfly myringoplasty method is safe and doesn’t require tympanomeatal flap elevation. Moreover, it shortens hospitalization time, facilitates anatomical closure of the membrane, and sometimes closes perforations in the anterior part, which cannot be clearly evaluated after graft placement.     

Three-point fix tympanoplasty

Conclusion: The three-point fix tympanoplasty procedure is a stable and effective technique – with a high degree of graft take and satisfactory hearing results – for reconstruction of most tympanic membrane (TM) perforations. Objective: It is difficult to repair a TM perforation, including subtotal perforation, involving the anterior part of the annulus. Reperforation can occur when an underlay graft technique is used. An overlay graft technique may result in anterior blunting/lateralization. We introduce a three-point fix tympanoplasty procedure, which can provide additional support to yield a stable graft. Methods: The study enrolled a total of 234 patients who underwent a three-point fix tympanoplasty procedure from November 2005 to June 2011. Anatomic success was defined as an intact, repaired TM, while functional success was defined as a significant decrease in the air–bone gap at the end of follow-up compared with preoperative hearing (air–bone gap). The complication rate was also analyzed. Results: The anatomic success rate was 93.2% (218/234 patients). The functional success rate after an average of 1 year was 73.5%. The postoperative average pure-tone air–bone gap (15.4 ± 11.4 dB) decreased successfully in comparison with the preoperative average air–bone gap (20.6 ± 12.1 dB). There were few postoperative complications (7.7%).     

Is type 1 tympanoplasty effective in elderly patients? Comparison of fascia and perichondrium grafts

Abstract

Background: Tympanoplasty is regularly performed in various ages but data about the procedure in elderly is insufficient.

Objectives: To compare the success rates and hearing outcomes of fascia and perichondrium grafts used for tympanoplasty in patients >65 years and to evaluate the prognostic factors affecting the success of tympanoplasty.

Methods: Reviewing records of 49 elderly patients underwent tympanoplasty, two groups were constituted: perichondrium (25 patients) and fascia (24 patients) groups. Ages, genders, perforation sides, type and location of perforation, graft success rates, functional success rates and air–bone gap (ABG) gains were compared.

Results: Overall graft success rate was 85.7%. After a mean follow-up of 23.3?±?8.32 months, overall mean ABG gain was 11.33?±?8.42?dB. Overall median postoperative ABG value (9?dB) was significantly lower compared to the median preoperative value (24?dB) (p?<?.001). Graft success rate was higher in perichondrium group (96%) compared to fascia group (75%) (p?=?.04). Functional success rate did not significantly differ between perichondrium (68%) and fascia groups (62.5%) (p?=?.68).

Conclusion and significance: Tympanoplasty is an effective procedure with a graft success rate of 85.7% in elderly. Both fascia and perichondrium are suitable materials; however, perichondrium had higher success rate.     

Postoperative results of simple underlay myringoplasty in better hearing ears

Conclusions. Simple underlay myringoplasty with fibrin glue (SUM) is indicated for repair of tympanic membrane (TM) perforation in the better hearing ear because postoperative hearing deterioration is extremely rare. Objective. To evaluate the postoperative results, including the hearing and the re-perforation rate, in the better hearing ear. Materials and methods. The procedure of SUM is removal of the perforation edge and bonding of the graft to the remnant TM with a few drops of fibrin glue by underlay technique. This method was applied to 75 patients with a perforated TM in the better hearing ear. The postoperative hearing and the re-perforation rate were investigated. Results. The mean of the postoperative hearing gain was 10.3 dB and no cases of postoperative hearing loss were observed. Although postoperative re-perforation was found in 18 cases (24.0%), the re-perforation was closed in 16 of these cases in the outpatient department by the same procedure using frozen autologous tissue that had been harvested previously in surgery. Including these cases, the total success rate was 97.3%.     

Modified inlay butterfly cartilage myringoplasty: An outpatient minimally invasive procedure for closure of central perforation-graft success rate and hearing outcome

ObjectiveThe objective of this was to evaluate anatomical and hearing results of modified inlay butterfly perichondrium-cartilage myringoplasty for repairing central perforation in an office setting.Material and methodsWe performed a prospective study in 81 patients with chronic central perforations who underwent modified inlay butterfly perichondrium-cartilage myringoplasty in an office setting. The graft success rate, hearing outcome, and complications were evaluated at postoperative 3, 6 and 24 months.Results81 patients with 81chronic perforations were included in this study. The graft success rate was 100.0% (81/81) at postoperative 3 months. At postoperative 24 months, 16 patients lost follow-up, the graft success rate was 98.5% (64/65). The mean preoperative ABG was 23.0 ± 2.6 dB, while the mean postoperative ABG postoperatively 12 months was 11.4 ± 3.1 dB; the difference between these values was significant (P < .05). No graft-related complications (e.g., graft lateralization, graft medialization, graft keratin pearl, middle ear cholesteatoma) were encountered during the follow-up period. In addition, excess perichondrium lateral to the superficial layer of TM remnant became necrotic and crust at postoperative 2–3 months. However, graft keratin pearl and intra-tympanic cholesteatoma/epithelial inclusion cyst weren't found in any patients at postoperative 24 months. Granular myringitis with minimal moistness but without infection has been noted in 6 patients.ConclusionsModified inlay butterfly perichondrium-cartilage myringoplasty is a viable and less invasive option for closure of central perforations in an office setting because this technique does not require tympanomeatal flap elevation and general anesthesia.     

A new grafting technique for tympanoplasty: tympanoplasty with a boomerang-shaped chondroperichondrial graft (TwBSCPG)

The aim of this study was to introduce a new grafting technique in tympanoplasty that involves use of a boomerang-shaped chondroperichondrial graft (BSCPG). The anatomical and functional results were evaluated. A new tympanoplasty with boomerang-shaped chondroperichondrial graft (TwBSCPG) technique was used in 99 chronic otitis media patients with central or marginal perforation of the tympanic membrane and a normal middle ear mucosa. All 99 patients received chondroperichondrial cartilage grafts with a boomerang-shaped cartilage island left at the anterior and inferior parts. Postoperative follow-ups were conducted at months 1, 6, and 12. Preoperative and postoperative audiological examinations were performed and air–bone gaps were calculated according to the pure-tone averages (PTAs) of the patients. In the preoperative period, most (83.8 %) air–bone gaps were ≥16 dB; after operating using the TwBSCPG technique, the air–bone gaps decreased to 0–10 dB in most patients (77.8 %). In the TwBSCPG patients, the mean preoperative air–bone gap was 22.02 ± 6.74 dB SPL. Postoperatively, the mean postoperative air–bone gap was 8.70 ± 5.74 dB SPL. The TwBSCPG technique therefore decreased the postoperative air–bone gap compared to that preoperatively (p = 0.000, z = ?8.645). At the 1-month follow-up, there were six graft perforations and one graft retraction. At the 6-month follow-up, there were nine graft perforations and three graft retractions. At 12 months, there were seven graft perforations and four graft retractions. During the first year after the boomerang tympanoplasty surgery, graft lateralization was not detected in any patient. Retractions were grade 1 according to the Sade classification and were localized to the postero-superior quadrant of the tympanic membrane. The TwBSCPG technique has benefits with respect to postoperative anatomical and audiological results. It prevents perforation of the tympanic membrane at the anterior quadrant and avoids graft lateralization due to placement of the graft under the manubrium mallei. Given these benefits, the TwBSCPG technique seems to be a good alternative for grafting in tympanoplasties.     

Medial or medio-lateral graft tympanoplasty for repair of tympanic membrane perforation

Objective

To describe and evaluate the medio-lateral graft tympanoplasty¹ for the reconstruction of anterior or subtotal tympanic membrane (TM) perforation and medial graft tympanoplasty for posterior TM perforation.

Methods

Retrospective study of 200 patients who underwent medio-lateral graft tympanoplasty (100 cases) and medial graft tympanoplasty (100 cases) at community and tertiary care medical centers from 1995 to 2006. All patients underwent preoperative and postoperative audiograms. In the medial graft tympanoplasty, the graft is placed entirely medial to the remaining TM and malleus. First, margin of TM perforation is denuded removing ring of squamous tissue. Tympanomeatal flap is elevated. Temporalis fascia is harvested, semidried, and grafted medial to the TM perforation and malleus with Gelfoam packing supporting the graft. In the medio-lateral graft technique, posterior tympanomeatal flap is elevated same as in the medial graft tympanoplasty first. Anterior-medial canal skin is elevated down to the annulus. At the annulus only squamous epithelial layer of TM is elevated up to anterior half of the TM perforation. Temporalis fascia is grafted medial to posterior half of the perforation and lateral to anterior half of the de-epithelialized TM perforation up to the annulus. Anterior canal skin is rotated to cover the fascia graft and TM perforation as a second layer closure. Patients were followed for at least six months. Outcome was considered successful if TM is healed and intact.

Results

There were four failures (96% success rate) in medial graft method for posterior TM perforation due to infection and re-perforation. In the medio-lateral graft tympanoplasty, there were three failures (97% success rate) due to a postoperative infection, anterior blunting and recurrent cholesteatoma.

Conclusion

The medial graft tympanoplasty works well for posterior TM perforation. The medio-lateral graft method is an excellent method for the reconstruction of large anterior or subtotal TM perforation. This new method should help otologic surgeons to improve outcome of tympanoplasty for anterior or subtotal TM perforation.     

Endoscopic perichondrium-cartilage button technique for repairing chronic large perforations in teenagers

ObjectiveThe objective of this study was to evaluate the graft outcome and complications of endoscopic perichondrium-cartilage button technique for repairing chronic large perforations in teenagers.Study designProspective case series.Materials and methods56 patients with chronic large perforations more than 50% of the TM who underwent endoscopic perichondrium-cartilage button technique. The graft success rate, hearing outcome, and complications were evaluated at postoperative 3, 6 and 12 months.ResultsOf the 56 ears, 3 (5.4%) patients lost follow-up, 53 (94.6%) patients were finally included in this study. The mean operation time was 37.2 ± 5.4 min. The retrograde tympanomeatal flap elevation was performed in 16 (30.2%) patients.The graft success rate was 96.2% (51/53) at postoperative 3 months and 94.3% (50/53) at postoperative 12 months. The mean preoperative ABG was 25.0 ± 3.7 dB, while the mean postoperative ABG postoperatively 6 months was 12.8 ± 3.1 dB; the difference between these values was significant. No graft-related complications (e.g., graft lateralization, significant blunting, and graft medialization) were encountered during the follow-up period. However, graft keratin pearl was noticed in 5.7% (3/53) patients, which occurred in the handle of malleus in 2 and antero-inferior margin in one. All the graft pearls were endoscopically removed in the outpatient setting.ConclusionsEndoscopic perichondrium-cartilage button technique can be achieved in every teenager patient with chronic large perforation without cholesteatoma, and, is a safe and efficient procedure.     

Effect of esterified hyaluronic acid as middle ear packing in tympanoplasty for adhesive otitis media

Objectives: The goal of this study was to evaluate the effects of middle ear packing agents (MEPA) on post-operative hearing improvement and complications after tympanoplasty in patients with adhesive otitis media (OM).

Materials and methods: Patients with adhesive OM who underwent tympanoplasty surgery were enrolled in the study between January 2012 and January 2015. A total of 205 patients who received canal wall-down tympanoplasty with ossicular chain reconstruction were randomized into one of the three groups with different MEPA. Group 1 (n?=?72) received MeroGel as the MEPA, Group 2 (n?=?64) cartilage, and Group 3 (n?=?69) both. Air conduction (AC) and bone conduction (BC) thresholds at 0.5, 1, 2, and 4?kHz were measured, and air-bone gaps (ABG) were analyzed before and after the surgery for each patient.

Results: Mean pre- and post-operative ABG was 30.9?dB and 17.6?dB in Group 1, 31.4?dB and 21.9?dB in Group 2, and 32.2?dB and 19.1?dB in Group 3. The ABG closure was 13.3?±?7.5 in Group 1, 9.5?±?5.9 in Group 2, and 13.1?±?9.3 in Group 3. The improvement of ABG after surgery was statistically significant in all three groups (p?p?Conclusions: Tympanoplasty using esterified hyaluronic acid (i.e. MeroGel) or cartilage as the MEPA resulted in improved hearing for patients with conductive hearing loss due to adhesive OM. Using MeroGel as the MEPA appeared to achieve a better post-operative outcome than using cartilage.     

Endoscopic modified perichondrium-cartilage sandwich graft for repairing chronic subtotal and total perforations

ObjectiveThe objective of this study was evaluate the short-and long-term graft outcome and complications of endoscopic modified perichondrium-cartilage sandwich graft for repairing chronic subtotal and total perforations.Study designProspective case series.Materials and methods135 patients with chronic subtotal and total perforations who underwent endoscopic modified perichondrium-cartilage sandwich graft technique. The graft success rate, hearing outcome, and complications were evaluated at postoperative 6 and 24 months.Results124 patients were finally included in this study. The graft success rate was 96.3% in subtotal perforation and 97.7% in total perforation (P = 0.874), with an overall success rate of 96.8% at postoperative 6 months. The graft success rate was 95.8% (68/71) in subtotal perforation and 94.9% (37/39) in total perforation (P = 0.795), with an overall success rate of 95.5% (105/110) at postoperative 24 months. The mean ABG improved from 28.0 ± 5.3 dB preoperatively to 14.9 ± 4.8 dB postoperatively 12 months (P < 0.05) for subtotal perforations; from 33.4 ± 7.4 dB preoperatively to 16.1 ± 2.4 dB postoperatively 12 months (P < 0.05) for total perforations. No graft-related complications (e.g., graft lateralization, significant blunting, graft medialization) were encountered during the follow-up period. Of the 110 patients, temporal bone CT revealed well pneumatization of the middle ear and mastoid region. However, graft keratin pearl was noticed in 1.8% (2/110) patients.ConclusionsEndoscopic modified perichondrium-cartilage sandwich graft for repairing subtotal and total perforations had excellent short and long-term graft success rate with less time-consuming and minimal complications.     

Surgical results of modified canal wall down tympanoplasty

Conclusion: Patients with mastoiditis and chronic suppurative otitis media which has small mastoids that make them ideal candidates for modified canal wall down mastoidectomy (MCWD) which contributes to a dry and spacious ear and the maintaining and improving hearing.

Objectives: To evaluate surgical outcomes for chronic otitis media underwent MCWD.

Methods: A clinical retrospective study was performed on 47 ears with chronic otitis media which has relatively limited attic lesions have the small, sclerotic and hypocellular mastoids according to the preoperative high-resolution CT scan of the temporal bone that underwent MCWD and 32 ears with typical canal wall down operation form January 2010 to January 2016.

Results: In the MCWD group, the mean preoperative air conduction (AC) threshold of 38.2?±?1.1?dB was lowered to 31.0?±?0.8?dB postoperatively (p?p?p?p?相似文献   

Clinical and audiological short-term and long-term outcomes of fat graft myringoplasty

Introduction: Results of fat graft myringoplasty are often reported with only short-term follow-up. Audiological results are less commonly reported, as well as long-term follow-up results.

Materials and methods: One hundred consecutive patients scheduled for fat graft myringoplasty were included in a prospective cohort study. Clinical and audiological outcomes were assessed at six weeks and one year postoperatively.

Results: Perforation sizes ranged from 0.5 to 4?mm. The six-week follow-up showed a total perforation closure rate of 72.9% with a statistically significant (p?=?.03) higher rate for the pediatric age group (83.0%). 64.4% of all patients were healed at one-year follow-up. Statistical analyses for background factors did not reveal any significant difference in healing rates with regard to patient sex or location or cause of the perforation. The mean preoperative air-conduction (AC) threshold was 25?dB with an air-bone gap of 12?dB. At the one-year follow-up the mean air conduction threshold for healed ears was improved to 16.6?dB, still 54.2% of them had a type B tympanogram.

Conclusions: Children had a higher perforation closure rate at six-week follow-up than adult patients. Recurrent tympanic membrane perforations were common after initially successful fat graft myringoplasties. Long-term hearing was improved after successful fat graft myringoplasty, resulting in a mean AC threshold of 16.6?dB.     

Outcomes of the Baha Attract System combined with auricle reconstruction in mandarin speaking patients with bilateral microtia-atresia

Background: A transcutaneous bone-conduction hearing device (tBCHD), the Baha Attract System has been recently introduced to China, and very few studies have assessed the efficacy of this system in speakers of mandarin.

Objectives: This study aims to analyze the functional and cosmetic outcomes of this system.

Materials and Methods: This prospective study included 11 patients (nine males, two females), of mean age 16 years (range 9–32 years). Seven patients were conducted the implantation simultaneously with auricle reconstruction, and the other four were before it. Auditory results were compared between unaided patients and implanted patients. Subjective satisfaction was analyzed using three questionnaires.

Results: The mean sound field thresholds were 65.9?±?5.1?dB SPL unaided and 30.9?±?4.7?dB SPL with an implanted Baha Attract System, resulting in a mean hearing gain of 35.0?±?6.7?dB. The mean WRS scores were 47.8?±?8.7% unaided and 92.1?±?2.0% with the Baha Attract System, resulting in a mean improvement of 47.8?±?8.7%. No adverse events were reported and questionnaires showed good patients satisfaction.

Conclusions: The transcutaneous Baha Attract System is effective in mandarin speaking patients, and the combination of hearing rehabilitation and auricle reconstruction surgery is promising for patients with bilateral microtia-atresia.     

The development and evaluation of the Finnish digit triplet test

Objectives: The aim of the study was to develop a reliable and easily accessible screening test for primary detection of hearing impairment.

Methods: Digits 0–9 were used to form quasirandom digit triplets. First, digit specific intelligibility functions and speech recognition thresholds (SRTs) were determined. To homogenize the test material digits with steep intelligibility function slopes were chosen and level correction up to ±2?dB were applied to the digits as needed. Evaluation measurements were performed to check for systematic differences in intelligibility between the test lists and to obtain normative reference function for normal-hearing listeners.

Results: The mean SRT and the final slope of the test lists were ?10.8?±?0.1?dB signal-to-noise ratio (SNR) and 21.7?±?1.8%/dB, respectively (measurements at constant level; inter-list variability). The mean SRT and slope of the test subjects were ?10.8?±?0.5?dB SNR and 23.4?±?5.2%/dB (measurements at constant level; inter-subject variability). The mean SRT for normal-hearing young adults for a single adaptive measurement is ?9.8?±?0.9?dB SNR.

Conclusion: The Finnish digit triplet test is the first self-screening hearing test in the Finnish language. It was developed according to current standards, and it provides reliable and internationally comparable speech intelligibility measurements.     

Septal perforation repair: mucosal regeneration technique

A novel method for repair of septal perforations. Fifteen volunteers with symptomatic septal perforations were recruited. Open technique rhinoplasty approach was preferred: auricular conchal cartilage graft with intact perichondrium on both sides was harvested and shaped to fit the perforated site and attached to the septum with absorbable sutures. All margins of the graft were covered with nasal mucosa. The severity of patient symptoms was assessed at preoperation, 3 and 6?months postoperatively via visual analogue scale (VAS). Crust formation, whistling, nasal blockage, epistaxis and overall comfort were evaluated. Mucosal physiology was assessed by nasal mucociliary clearance time. The mean age of the patients was 47.3?years. Average perforation size was 1.86?±?0.78?cm. 14/15 (93.3%) perforations were repaired, and only one patient required revision surgery. VAS scores improved significantly (p?<?0.001). Mean mucociliary clearance time improved from 17.6?±?3.83 to 10.3?±?3.30?min and 9.3?±?3.36?min at 3 and 6?months, respectively. This is a novel, simple and safe method for repairing the deficient mucosal area in septal perforations up to 25?mm in diameter.     

Use of a platelet-rich fibrin membrane to repair traumatic tympanic membrane perforations: a comparative study

Objectives: (1) To evaluate the effects of a platelet-rich fibrin (PRF) membrane in the repair of traumatic tympanic membrane (TM) perforations; and (2) to compare the use of a PRF membrane with the paper patch technique with regard to recovery rates, healing time, and correction of the mean air–bone gap.

Methods: A randomized, prospective analysis was performed for 60 patients who were treated for traumatic TM perforations using one of the two methods. Closure rate, speed of healing, and hearing gain were compared between the PRF (Group 1) and paper patch (Group 2) groups.

Results: Closure was obtained in 28 (93%) perforations in Group 1 and 25 (83%) perforations in Group 2 (p?>?0.05). On day 10, full closure of the TM was observed in 24 (80%) patients in Group 1 and 16 (53%) patients in Group 2 (p?p?Conclusions: In comparison with the paper patch method, PRF, a new method, provided more rapid healing with more successful audiological results, and with no requirement for a second procedure.     

Acquired stenosis of the external auditory canal – long-term results and patient satisfaction

Background: The surgical treatment of acquired post-inflammatory atresia of the external auditory canal (EAC) is challenging. Based on the long-term surgical experience, a modified split skin graft technique has been established at our clinic.

Aims/Objectives: The aim was to evaluate the clinical and audiological data and patient satisfaction after performing meatoplasty.

Material and methods: In total, 16 patients were included who underwent intraoperative enlargement of the bony EAC, resection of the fibrotic scar tissue, reconstruction with split skin grafts and splinting of the anterior tympanomeatal angle in the period of 2004–2016. Patients presented at a long-term follow-up appointment for reevaluation.

Results: The mean follow-up time was 52 months after surgery. The pure-tone average (52?dB vs. 31?dB) and the air-bone gap (27?dB vs. 11?dB) decreased significantly compared to the preoperative status. The grade of stenosis also showed a significant improvement during the follow-up visit. Complete re-atresia was observed only in two patients (10.5%).

Conclusion: The applied surgical technique is a safe and successful treatment option for acquired atresia of the EAC.

Significance: The study provides important data for the surgical treatment of acquired atresia of the EAC and corroborates the significance of intensive aftercare.     

耳内镜下颞肌筋膜四点固定法鼓膜修补术的临床疗效

目的 探讨采用耳内镜下颞肌筋膜"四点固定法"修补鼓膜穿孔，观察其临床疗效。方法 选取北京大学第三医院耳鼻咽喉科2020年12月-2021年6月因鼓膜紧张部前方或中央型大穿孔的患者19例随机分为两组。观察组10例（12耳），行耳内镜下"四点固定法"鼓膜修补术，注意下方鼓沟表面、锤骨柄内侧面、后方鼓沟与鼓索神经表面及前上部鼓环与鼓沟之间的裂隙四处关键点的固定；对照组9例（9耳），采用带软骨膜的耳屏软骨进行耳内镜下鼓膜修补术。所有患者术后3个月分别采用耳内镜及纯音听力检查进行客观评估，采用汉化版苏黎世慢性中耳炎量表（ZCMEI）对患者进行中耳炎症状、术后主观听力水平、社会心理影响及医疗资源进行生活质量评估。结果 观察组12耳术后2周穿孔基本愈合，鼓膜的形态更接近于正常浅凹型。穿孔修复成功率100%；对照组有1例前方遗留裂隙样穿孔，穿孔修复成功率88.9%。采用"四点固定法"，术后听力PTA（22.5±7.5）dB，ABG（10.0±8.2）dB，较术前的（35.1±12.6）dB和（21.7±8.2）dB有明显提高（P=0.009，P=0.011）。与对照组相比，观察组在0.25、0.5、1 kHz上术后气导较术前有显著性提高，而对照组仅在0.25 kHz处有显著性提高。生活质量评分两组在中耳炎症状、术后主观听力水平、社会心理影响及医疗资源占用四个维度的评分上无明显差异（P>0.05）。结论 耳内镜下采用颞肌筋膜"四点固定法"修补鼓膜，可以获得很高的修复成功率，且术后鼓膜形态更接近于自然的鼓膜形态，术后听力改善效果好，对于耳道宽敞、位于前方边缘的穿孔及对术后听力改善要求高的病例，可采用此方法进行鼓膜修补手术。