加速康复外科在耳内镜下鼓室成形术围手术期应用的临床研究

目的　对比加速康复外科和常规康复外科在耳内镜下鼓室成形术中的有效性和安全性。方法　收集本院2018年4月～2018年12月符合纳入标准的42例慢性化脓 性中耳炎患者,随机分为加速康复外科组和对照组,从患者术前情绪变化、术后疼痛、术后舒适度、术后不良反应、术后住院时间和住院费用进行比较。结果　加速康复外科组和对照组术前焦虑自评量表评分为（28.48±2.73）分和（35.71±6.02）分,两者比较,差异有统计学意义（t =-5.019,P＜0.05）;加速康复外科组和对照组术后Kolcaba舒适量表评分为（89.62±8.59）分和（82.95±9.03）分,两者比较,差异有统计学意义（t =-2.450,P＜0.05）;加速康复外科组和对照组术后视觉模拟量表评分为0（0,0）和1（0,2）分,两者比较,差异有统计学意义（Z =-3.624,P＜0.05）;加速康复外科组和对照组均无术后不良反应,在术后住院时间、住院费用方面无统计学差异（P＞0.05）。结论　加速康复外科能减轻耳内镜下鼓室成形术后疼痛,提高患者术后舒适度。     

鼓室成形术治疗慢性化脓性中耳炎术式的选择

目的：探讨鼓室成形术不同术式治疗各理亏是性化脓性中耳炎（ＣＳＯＭ）的手术疗效。方法：对１８９耳ＣＳＯＭ患者分别单纯鼓膜修补术、病灶清除＋听骨链成形＋鼓膜修补术。结果：鼓膜穿孔愈合率达９９％以上,听力有不同程度提高。结论：对不同类型的ＣＳＯＭ应采用不同术式的鼓室成形术,病变愈单纯,术后呼力改善愈佳,能适应较简单手术者,效果较佳。凡鼓室成形术,均应行鼓室探查。     

慢性化脓性中耳炎活动期鼓室成形术的临床观察

目的探讨慢性化脓性中耳炎活动期鼓室成形术的可行性和疗效。方法对37例单侧慢性化脓性中耳炎活动期患者在恢复咽鼓管功能、清除病变的同时行鼓室成形术,随访观察近期及远期疗效。结果术后1年复查,30例鼓膜形态正常,3例鼓膜再穿孔,4例鼓膜内陷。纯音测听气骨导差(air bone gap,ABG)平均缩小10dB者10例,15~20dB者15例,25~30dB者7例,无变化5例。结论慢性化脓性中耳炎活动期可行鼓室成形术。彻底清除病变,恢复中耳通气功能是手术成功的关键。     

开放式鼓室成形术治疗胆脂瘤中耳炎

目的：探讨开放式鼓室成形术治疗胆脂瘤中耳炎的疗效。方法：对23例胆脂瘤中耳炎患者行开放式鼓室成形术。结果：随访1～3年,23耳全部干耳,无胆脂瘤复发, 无眩晕和面瘫并发症。20例移植筋膜成活,2例鼓膜再穿孔,1例鼓膜疤痕内陷。术后纯音测听语言频率气导平均听阈,提高25～30dBHL 5耳,提高15～20dBHL 13耳,提高10dBHL 2耳,无变化3耳。结论：为胆脂瘤型中耳炎患者行开放式鼓室成形术,能根治病变,听力恢复效果好,复发率低,是一种较为实用的手术方法。     

联合进路鼓室成形术治疗慢性化脓性中耳炎

目的:探讨联合进路鼓室成形术治疗慢性化脓性中耳乳突炎的疗效.方法:对32例、34耳采用联合进路手术清除中耳乳突病变,同时一期完成鼓室成形术.结果:术后随访1～5年,鼓膜全部愈合, 形态良好,内陷2耳,无胆脂瘤复发.语言频率平均气导听力提高15dB以上31耳,占91.1%.结论:只要严格掌握手术适应证,正确彻底清除中耳乳突病变组织,可重建听力,术后获得满意疗效.     

完壁式乳突根治鼓室成形术治疗胆脂瘤中耳炎

目的:探讨完壁式乳突根治鼓室成形术治疗胆脂瘤中耳炎的临床效果和相关的经验教训.方法:对57例胆脂瘤中耳炎患者实施完壁式乳突根治鼓室成形术.结果:随访1～8年,平均3.7年.术后5例感染流脓,其中3例经及时处理得到控制并愈合,2例二次手术处理后愈合;3例术后因胆脂瘤复发行开放式乳突手术获干耳;鼓膜完整但有内陷者29例,其中2级内陷者13例;术后8个月及1年人工听骨脱出各1例.术后言语频率气导听阈降低>10 dB HL为72.2%(39/54),气骨导差<20 dB HL为53.7%(29/54),气骨导差缩小25 dB HL以上占42.6%(23/54).结论:施行完壁式乳突根治鼓室成形术,如果适应证掌握得当,技术条件许可,患者能按时随访.可以有效保留原中耳乳突解剖结构和改善听力,提高患者生活质量,应予优先选择该术式.     

胆脂瘤型和骨疡型中耳炎Ⅰ期鼓室成形术的疗效观察

目的：探讨胆脂瘤型和骨疡型中耳炎Ⅰ期鼓室成形术的可行性及疗效影响因素。方法：52例(52耳)慢性化脓性中耳炎(胆脂瘤型30耳，骨疡型22耳)患者在清除病变的同时行鼓室成形术，其中单纯鼓室成形术12耳，乳突根治加鼓室成形术40耳。结果：全部病例均干耳，无一例胆脂瘤复发。语频段听力提高30dB以上者5耳，提高20～29dB者9耳，提高10～19dB者31耳，小于10dB者7耳，无听力下降者。结论：胆脂瘤型和骨疡型中耳炎可行Ⅰ期鼓室成形术，鼓膜有效振动面积、镫骨及镫骨底板的活动度是影响听力的重要因素，咽鼓管功能不良是手术失败的主要原因。     

分期鼓室成形手术的疗效观察

目的 :探讨分期鼓室成形手术治疗慢性化脓性中耳炎的疗效。方法 :对 36例 (36耳 )本病患者 1期手术行乳突根治术 ,其中 2 6耳为开放式术式 ,10耳为关闭式术式。次期手术主要连接听骨链 ,其中 型 2耳 , 型 2 5耳 , 型 5耳 ;另 4耳无法成形者则行单纯乳突根治术。结果 :36例中 32例成功 ,4例失败。结论 :分期鼓室成形手术可挽救大部分慢性化脓性中耳炎患者的术后听力 ,在中耳粘膜增厚、粘膜缺损较小或术前咽鼓管不通的病例可获得较好的效果 ;但对中耳粘膜缺损较大的病例效果较差 ;手术成功的关键在于术后中耳形成含气空腔     

Postoperative change in wideband absorbance after tympanoplasty in chronic suppurative otitis media

ObjectiveTo identify the wideband absorbance (WBA) of reconstructed TM comparing with perforated and normal TM, and to investigate the efficacy of WBA to predict postoperative hearing outcome.MethodsNinety-eight adults (128 ears) with normal TM and 40 patients (40 ears) who were diagnosed with chronic suppurative otitis media (CSOM) and underwent tympanoplasty type 1 were enrolled. Pure tone audiometry and WBA were measured before and 6 and 12 months after surgery. Finally, only 29 patients in CSOM group completed all the tests.ResultsSignificant differences in WBA were observed between normal ears, CSOM, and reconstructed ears at middle to high frequencies. During follow-up, absorbance decreased at low frequencies and increased at middle to high. Significant positive correlation at low to middle frequency was observed between change in air-bone gaps (ABG) and absorbance at corresponding frequencies.ConclusionWBA in patients with CSOM was significantly different from normal TM, and a significant change in WBA was observed after tympanoplasty with improvement of ABG. WBA may be a useful tool for monitoring the postoperative change in absorbance of sound energy in the middle ear.     

慢性化脓性中耳炎鼓室成形术前后骨导听阈变化的临床观察

目的:探讨慢性化脓性中耳炎术前骨导听阈提高与术后骨导听阈变化的相关因素.方法:单侧慢性化脓性中耳炎行鼓室成形术45例,术前3 d内和术后3个月分别行常规纯音测听,术前患侧与健侧相比,骨导听阈0.25～8.00 kHz至少连续2个或2个以上频率增加≥10 dB为术前骨导听阈提高阳性;术后3个月与术前相比,0.25～8.00 kHz至少2个或2个以上频率减少≥10 dB为术后骨导听阈下降阳性,增加≥10 dB为术后骨导听阈提高阳性.结果:45例中35例(77.8%)术前骨导听阈提高阳性,与病程长短、是否伴有胆脂瘤无关,但与听骨链破坏有相关性(P＜0.05),听骨链中断易导致术前骨导听阈提高;术前骨导听阈提高阳性35例中有6例(17.1%)术后骨导听阈下降阳性;45例患者中有5例(11.1%)术后骨导听阈提高阳性.结论:慢性化脓性中耳炎可造成骨导听阈提高,鼓室成形术不仅可使气导听阈下降、缩小气骨导差,还可使骨导听阈下降;术中过多触动听骨链及噪声等可造成术后骨导听阈提高.     

软骨鼓膜修补联合Ⅲ型鼓室成形治疗粘连性中耳炎

目的探讨软骨鼓膜修补联合Ⅲ型鼓室成形治疗粘连性中耳炎的疗效。方法回顾性分析5 1例接受手术治疗的粘连性中耳炎患者,术中切除粘连的鼓膜及瘢痕组织,去除锤骨、砧骨,行Ⅲ型听力重建,穿孔的鼓膜用全厚耳屏软骨修补。结果5 1例患者均于术后4～6周干耳,鼓膜解剖形态基本正常,但稍厚,活动差。术后3个月纯音测听（0.2 5,0.5,1,2,4 kHz）骨气导差（ABG）为2 3.8 dB,提高了1 8.1 dB。术后1年为1 3.4 dB,提高了2 8.5 dB。随访1年以上,稍厚的软骨鼓膜变薄,活动能力好,无1例穿孔,声导抗测试鼓室图全为As型曲线。结论软骨鼓膜修补联合Ⅲ型鼓室成形治疗粘连性中耳炎效果显著,有临床应用价值。     

咽鼓管功能对行Ⅰ型鼓室成形术的慢性中耳炎患者短期听力影响分析

目的 通过对耳内镜下Ⅰ型鼓室成形术治疗慢性化脓性中耳炎患者的临床资料分析,探讨咽鼓管功能对其听力影响。方法 收集诊断为慢性化脓性中耳炎患者42例,结合声导抗正负压平衡试验和咽鼓管功能障碍评分量表(ETDQ-7)将分为咽鼓管功能障碍患者作为研究组(25例),将咽鼓管功能正常患者作为对照组(17例),对比分析两组患者手术前后听力的变化。结果 研究组术前与术后气导平均听阈、骨导平均听阈均高于对照组,差异具有统计学意义(P <0.05);研究组术后气导平均听阈和骨导平均听阈的改善值均高于对照组,差异无统计学意义(P> 0.05);研究组术后4 k Hz气导听阈改善值低于对照组,差异无统计学意义(P> 0.05);研究组术后8 k Hz气导听阈改善值低于对照组,差异有统计学意义(P <0.05)。结论 良好的咽鼓管功能不会增加Ⅰ型鼓室成形术对慢性化脓性中耳炎患者平均听力的改善程度,但有利于患者术后高频听力的恢复。     

鼓室成形术影响听力疗效相关因素分析

目的 探讨鼓室成形术听力疗效的相关影响因素.方法 报告118例（126耳）鼓室成形术,对可能影响听力疗效的16项因素进行分析.结果 病程短、病变轻、术前有较大骨气导间距、咽鼓管通畅、术中保留锤骨柄、选取适当术式以及术后完好鼓膜状态则听力效果较好,10项单因素经统计学分析均有显著性意义（P＜0.05）.结论 鼓室成形术听力疗效受多种因素影响,主要与病变程度及手术方法有关.     

Results of revision tympanoplasty for chronic non-cholesteatomatous otitis media

Objective

To evaluate the success rate for revision tympanoplasty using different graft materials, to compare results of primary and re-tympanoplasty using the same technique and to analyse the effect of potential influencing factors on closure of tympanic membrane (TM) and hearing outcome.

Methods

Study included all patients, who underwent tympanoplasty (n = 617) and re-tympanoplasty (n = 94) for chronic otitis media without cholesteatoma in the period between September 1998 and 2007. The data of all patients on preoperative disease, perforation size and localization, middle ear status, surgical approach, graft material, adjunctive procedures, pre- and postoperative morphological (otomicroscopy) and functional (hearing examination evaluating pure-tone audiogram) results were analyzed. All operations were performed using an underlay technique and either the retroauricular or transcanal approach. The temporal fascia, perichondrium or cartilage-perichondrium composite grafts were used for the reconstruction of TM. Ossiculoplasty was performed as needed. The interrelation between multiple pre-operative parameters and post-operative morphological (closure of the perforation) and functional (hearing level) outcomes was analysed.

Results

Successful closure rates of the TM perforation were 93.6% and 90.2% of the patients in the primary and revision tympanoplasty groups, respectively. Graft take rate and hearing results did not depend on graft material. Structural changes were found more frequently in the re-tympanoplasty group (63.4% comparing to 29.5% of primary cases). Ossiculoplasty was performed more often in revision cases (24.4% comparing to 11.4% of primary cases). Successful hearing (ABG within 20 dB) for primary tympanoplasties was achieved in 81.1%, and for retympanoplasty - in 69.5% of the cases. (p < 0.01). There were no interrelation between any estimated parameters and the graft take rate for either primary or revision tympanoplasty.

Conclusions

There is no evidence of increased risk of graft failure in re-tympanoplasty cases when compared to primary tympanoplasty operations. Hearing results depend on structural changes in the middle ear (ossicular abnormalities and tympanoscerosis) which in revision cases are found more often. No differences were found between fascia, perichondrum or cartilage-perichondrium grafts in terms of graft healing and hearing results.     

Long-term hearing results of one-stage tympanoplasty for chronic otitis media

Summary A study of 277 ears with chronic otitis media undergoing one-stage tympanoplasty has been carried out. The mean follow-up period was 6.4 years. Ears with intact ossicular chains were excluded. Ossiculoplasty was performed using autologous ossicles or cortical bone. Mean hearing gain was 10.8 dB. Closure of the postoperative air-bone gap to within 20 dB was achieved in 51% of cases. The best results were obtained in ears with intact stapes, while cholesteatomatous ears showed poorer results than other chronic ears. The present findings show that autologous ossicle and cortical bone are still suitable for ossicular reconstruction in chronic ears, especially when one-stage surgery is preferred.