开放式与完壁式鼓室成形伴听骨链重建术后效果对比分析

目的比较开放式与完壁式鼓室成形伴听骨链重建治疗中耳胆脂瘤的疗效,探讨中耳胆脂瘤手术方式的选择。方法 90耳中耳胆脂瘤分别行开放式鼓室成形伴听骨链重建术与完壁式鼓室成形术伴听骨链重建术。术后均随诊24个月,以术后干耳率、纯音平均听阈、平均气骨导差和听骨链重建成功率为指标进行评价,比较两组的疗效。结果开放式鼓室成形术后干耳率100%,未出现胆脂瘤复发;听力重建成功率62.8%。完壁式鼓室成形术后干耳率81.8%,胆脂瘤复发4耳(10.50%);听力重建成功率68.4%。结论开放式鼓室成形伴听骨链重建术是治疗中耳胆脂瘤安全有效的术式,术后干耳率高,并发症少,复发率低,听力重建效果良好。     

中耳术后感染对羟基磷灰石人工听骨的影响

目的 分析胆脂瘤中耳炎手术用羟基磷灰石人工听骨重建听力后感染和胆脂瘤复发的病例,探讨其发生机制.方法 回顾性分析胆脂瘤中耳炎手术用羟基磷灰石人工听骨重建听力后发生感染和胆脂瘤复发的4例病人的病史、术中所见、病理结果及治疗效果.结果 4例中有3例术后出现感染和上鼓室内陷袋,最终胆脂瘤复发,一例胆脂瘤侵及鼓窦、乳突,骨桥消失.1例因再次感染后羟基磷灰石人工听骨呈解体状态.结论 胆脂瘤中耳炎术后复发的机制可能是感染和病变清理不彻底,中鼓室与上鼓室通气阻塞而形成负压,上鼓室回缩袋形成.改进手术技巧可预防中耳术后胆脂瘤复发.     

采用钛质听骨行Ⅰ期鼓室成形术的临床观察

目的：为了提高慢性化脓性中耳炎、胆脂瘤型中耳炎手术治疗效果。方法：对慢性化脓性及胆脂瘤型中耳炎３２例采用单纯鼓室成形、联合进路鼓室成形及开放性鼓室成形三种术式，以钛质人工听骨行听骨链重建，Ⅰ期完成手术方法治疗。结果：随诊２年内听力提高〉１５ｄＢＨＬ者１２例，听力达应用水平者２０例，鼓膜愈合良好，未发现胆脂瘤复发及移植听骨排异现象。结论：结果表明采用上述三种术水平者２０例，鼓膜愈合良好，未发现胆脂瘤     

采用钛质听骨行Ⅰ期鼓室成形术的临床观察

目的 :为了提高慢性化脓性中耳炎、胆脂瘤型中耳炎手术治疗效果。方法 :对慢性化脓性及胆脂瘤型中耳炎 32例采用单纯鼓室成形、联合进路鼓室成形及开放性鼓室成形三种术式 ,以钛质人工听骨行听骨链重建 , 期完成手术方法治疗。结果 :随诊 2年内听力提高 >15 d BHL 者 12例 ,听力达应用水平者 2 0例 ,鼓膜愈合良好 ,未发现胆脂瘤复发及移植听骨排异现象。结论 :结果表明采用上述三种术式 期完成手术 ,以钛质人工听骨重建听骨链能达到提高听力的目的。     

消除乳突腔的改良完壁式乳突根治术治疗重症慢性中耳炎

重症慢性中耳炎的手术治疗应该达到：①完全清除病变组织，尤其是胆脂瘤；②消除可能引起复发的解剖结构；③重建一定的听力传导装置。声波的运动需要保留通到鼓膜的空间及一定形态的外耳道。开放耳道后壁的术式虽能满意地清除病变、防止复发，但有丧失听力和术腔创面难以愈合之弊；保留耳道后壁的术式虽可无上述情况，但因保留上鼓室和乳突气房易于形成回缩袋而胆股瘤复发。该作者吸取上述两术式的优点，采用自体组织填塞完全消除乳突腔、将上鼓室暴露于外耳道、保留耳道后壁并形成小鼓室重建听力的改良乳穷根治术。手术对象为上鼓室鼓窦胆…     

上鼓室胆脂瘤与听骨链重建术

目的探讨上鼓室胆脂瘤患者在凿开上鼓室,清除胆脂瘤组织后重建上鼓室壁并一期听骨链恢复传音功能的方法和效果.方法对上鼓室胆脂瘤23例行上鼓室凿开术,清除胆脂瘤上皮组织;酌情剪除锤骨头,取出砧骨体,然后行镫骨头上加高或锤骨长柄、镫骨头连接术.观察术后鼓膜愈合及听力恢复情况.结果随访23例4～12年,20例鼓膜愈合良好,2例鼓膜后上方外移,1例鼓膜发生2mm穿孔并且胆脂瘤复发.术后气骨导差值＜10dB 8例,＜20dB 6例,＜30dB 6例,30dB以上3例.以镫骨头上加高听力恢复最好.结论上鼓室胆脂瘤患者应以清除胆脂瘤上皮为前提,清除病变后根据情况重建上鼓室壁和听骨链,有助于恢复听力.     

开放式鼓室成形术中听骨链重建效果及其影响因素

目的 探讨胆脂瘤中耳炎患者行开放式鼓室成形伴听骨链重建的效果和影响因素.方法 分析142例胆脂瘤患者,行开放式鼓室成形术伴一期听骨链重建,随访24月,记录术后并发症、纯音平均听阈、平均气骨导差和听力重建成功率.结果随访期间未发现鼓膜内陷袋形成及胆脂瘤复发,术后干耳率达96.5%,听骨赝复物脱出4例(2.8%),气导平均听阈降低11.6dB,气骨导差较术前缩小7.4dB,70例患者气骨导差<20dB,听力重建总成功率达49.3%.听力重建成功的关键主要取决于术腔感染控制、咽鼓管功能、病变范围、听骨赝复物材料和手术技术.结论 虽然影响因素较多,开放式鼓室成形伴一期听骨链重建仍是胆脂瘤中耳炎患者安全有效的术式,术后并发症少,复发率低,听力重建效果令人满意.     

胆脂瘤手术耳道骨整块回复及听力效果观察

胆脂瘤手术后恢复听力和预防复发仍是目前耳外科难题之一：完壁法对恢复和保护听力是比较理想的方法，但是存在较高的残留和复发率。我们2002年1月～2002年12月应用新型微型气钻铣切割技术做耳道骨整块回复，比较圆满地综合解决了胆脂瘤术后外耳道壁重建、上鼓室乳突再气化、听力改善或保持到基本正常水平．报道如下。     

保留或重建部分外耳道后骨壁的乳突根治鼓室成形术

目的探讨乳突根治鼓室成形术中保留或重建部分外耳道后骨壁对提高胆脂瘤型中耳炎术后患者的干耳率及听力水平的意义.方法保留部分外耳道后壁24例、25耳,重建外耳道部分后壁6例、6耳,均行I期鼓室成形术.结果 术后随访11个月～4年,术后干耳并提高听力达实用听力(25dB以上)23耳,治愈率 82.1%;复发4耳,复发率12.9%.结论在乳突根治鼓室成形术中保留或重建部分外耳道后骨壁有利于增加中耳含气腔,提高听力;且有利于术后观察乳突腔病变, 避免胆脂瘤复发,提高干耳率.     

上鼓室进路并外耳道及鼓室成形术的临床分析

目的:观察上鼓室切开结合外耳道和鼓室成形术治疗主要局限于上鼓室胆脂瘤的临床疗效。方法:采用上鼓室进路治疗31例病灶主要限于上鼓室的胆脂瘤患者,并于清除病灶后,用耳屏或耳甲腔软骨/软骨膜行外耳道成形和鼓室成形术,重建上鼓室外侧壁和恢复传音结构。结果:经上鼓室外侧壁重建和鼓室成形术后,除2耳鼓室硬化者外,余听力都有提高或保持正常状态,仅有1例出现鼓膜穿孔,31例均未发现囊袋状内陷或胆脂瘤再发。结论:上鼓室切开进路,I期用软骨/软骨膜行外耳道成形和鼓室成形术,较好地恢复了外耳道及中耳结构形态和功能,对治疗局限于上鼓室的胆脂瘤和防止复发的效果好。     

Surgical results of canal wall reconstruction tympanoplasty in middle ear cholesteatoma

Materials were 236 ears of 213 patients with middle ear cholesteatoma undergoing canal wall reconstruction during 1993-1998. Subjects were followed up for at least 1 year after final operation. Of 236 ears, 147 (62%) underwent 1-stage operation and 89 ears (38%) required 2-stage operation. Hearing results were successful in 157 ears (67%) based on criteria proposed by the Otological Society of Japan. The success in ears undergoing 1-stage operation was 74% and 54% in ears undergoing 2-stage operation. Postoperative hearing and air-bone gap in the 1-stage group were significantly better than in the 2-stage group. For tympanoplasty, success was 97% in type I, 64% in type III, and 53% in type IV. The likelihood of undergoing 2-stage operation increased with the type of tympanoplasty, from type I to IV. Postoperative hearing was significantly worse in older age groups. Of the 89 ears, 13 (15%) had recurrent cholesteatoma and 29 (33%) had residual cholesteatoma at 2-stage operation. In the 135 in the 1-stage group, recurrent cholesteatoma was observed at follow-up in 13 ears (9.6%). When we analyzed clinical risk factors for both recurrent and residual cholesteatoma in age, gender, otorrhea, types of cholesteatoma, and types of tympanoplasty, no significant factors were seen for recurrent or residual cholesteatoma. These results indicate that canal wall reconstruction tympanoplasty for middle ear cholesteatoma yields relatively good hearing results. However, more effort is needed to reduce the incidence of recurrent and residual cholesteatoma.     

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.     

Postoperative results for cholesteatoma in children

OBJECTIVES: to review the postoperative results for cholesteatoma in children. MATERIALS: 32 ears with acquired cholesteatoma in children operated on by a single surgeon between 1987 and 1995 and followed up more than 2 years. The mean follow-up period was 5.4 years. RESULTS: a one-stage operation was performed in seven ears (21.9%) and preplanned stage operation in 25 ears (78.1%). In the first operation, closed tympanoplasty was performed in 31 ears (96.9%) and open tymapanoplasty in one ear (3.1%). During the second stage operation, residual cholesteatoma was found in 16 ears (64.0%). Recurrent cholesteatoma was detected in 19.4% of ears treated with closed tympanoplasty. The mean postoperative air conduction hearing level was within 20 dB in 12.5%, 30 dB in 40.6% and 40 dB in 78.1%. The hearing results of type III tympanoplasty was better than those of type IV tympanoplasty. CONCLUSIONS: preplanned stage tympanoplasty is safer because of the high risk of recurrent and residual cholesteatoma. Surgical methods should be selected flexibly in individual cases depending upon cavity size, eustachian tube function and hearing level. Cholesteatoma in children should be operated on while stapes is present.     

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...     

A retrospective study on post-operative hearing of middle ear cholesteatoma patients with labyrinthine fistula

Conclusions: There is no significant change in bone conduction threshold after operation, so the tympanoplasty can be done to maintain hearing when conditions allow. Objective: To study the impact of surgical treatment on hearing of cholesteatoma patients with labyrinthine fistula. Methods: The clinical data of 35 patients (35 ears) with labyrinthine fistula, which were caused by cholesteatoma, were analyzed retrospectively. The hearing of 21 patients was followed up. Results: Three months to 5 years follow-up of 21 patients were accomplished by pure tone audiometry and other details. There was no recurrent cholesteatoma in the patients. Compared with pre-operative average bone conduction at 0.5, 1, 2, 4, and 8 kHz, 12 cases had a difference less than 5 dB, three patients’ hearing improved (more than 10 dB), and five cases declined (more than 10 dB). One patient received cochlear implantation 3 months after the surgery. The average bone and air conduction thresholds at 0.5, 1, 2, 4, and 8 kHz had no obvious change (p?>?0.05) in 11 patients managed by a canal wall down mastoidectomy with tympanoplasty.     

影响听力重建手术疗效的相关因素分析

目的探讨听力重建手术疗效,并对其相关影响因素进行分析。方法对97例(99耳)慢性中耳炎患者均行开放式乳突根治并重建听骨链、成型鼓室,分析其临床资料,对可能影响听力重建疗效的10项因素进行logistic回归分析。结果纯音测听示术前气导平均听阈(47.3±9.0)dB,术后(32.1±8.7)dB;术前ABG平均为(31.7±9.3)dB,术后ABG平均为(16.7±8.8)dB。其中镫骨存在、咽鼓管通畅、鼓膜张肌腱存在对听力重建疗效具有统计学意义。结论多个因素影响听力重建手术的疗效,其中镫骨情况、鼓膜张肌腱、咽鼓管功能是较为主要的因素。     

上鼓室填塞术在开放式鼓室成形术中的应用

目的 探讨上鼓室填塞术在开放式鼓室成形术中的作用.方法 2010年～2015年对100例(100耳)慢性化脓性中耳炎患者行开放式鼓室成形术,术中均采用自体骨粉填塞上鼓室,术后6个月复查纯音听阈,随访1～5年,观察术后术腔及听力恢复情况.结果 100例(100耳)中,术后1～6月发生术腔感染5耳,术后1年再次发生内陷袋1耳;0.5、1、2 kHz气导纯音平均听阈由术前的43.2±2.3 dB HL下降至术后的29.8±1.7 dB HL(P＜0.01),术后气骨导差较术前缩小10.6±0.5 dB (P＜0.01).结论 开放式鼓室成形术中上鼓室自体骨粉填塞可以防止术后内陷袋再次形成,术后听力恢复满意,但前提是必须彻底清除病变.     

Hearing results of canal wall reconstruction tympanoplasty for middle ear cholesteatoma in children.

OBJECTIVE: To investigate post-operative hearing results in children with middle ear cholesteatoma, and to analyze the correlation between hearing results and clinical factors and findings before and during the operation. PATIENTS AND METHODS: One hundred and twenty-four ears of 123 children were operated on for middle ear cholesteatoma at the age of 10 years or younger by canal wall reconstruction tympanoplasty and were followed up more than 1 year after the final operation. We evaluated the average air and bone conduction hearing levels at the speech ranges before the first operation (pre-operative hearing) and after the final operation (post-operative hearing). RESULTS: The mean of the average air conduction hearing level of 124 ears was significantly improved from 34.7 to 27.1 dB after the final operation. Among them, 84 ears (67.8%) showed a hearing level of 30 dB or less post-operatively. Post-operative hearing was better in the one-stage group than in the staged group. However, more than one-half of the ears which underwent type IV tympanoplasty in the staged group showed post-operative air conduction hearing level of < or =30 dB. Significant improvement in post-operative hearing was noted in ears with normal middle ear mucosa or middle ear effusion at the final operation. No correlation between hearing improvement and clinical factors such as age, type of cholesteatoma or presence of otitis media with effusion at the first operation was found. CONCLUSIONS: Children with middle ear cholesteatoma at the age of 10 years or younger exhibited good hearing post-operatively. Satisfactory hearing improvement is expected even in ears without the superstructure of the stapes if staged tympanoplasty is conducted. Canal wall reconstruction tympanoplasty for pediatric cholesteatoma was successful in terms of hearing results and the success was unrelated to various clinical factors.     

Congenital aural cholesteatoma: Results of surgery in 60 cases

From 1978 to 1993, 59 patients (60 ears) with congenital middle ear cholesteatoma were treated at the House Ear Clinic. The median patient age at presentation was 5 years, and the period of postoperative follow-up was 4.8 years. An intact canal wall was maintained in 58 of 60 cases and a closed middle ear space in all cases. In 12 operations, lateral graft tympanoplasty eradicated the cholesteatoma in one stage; 32 patients required a second-stage surgery to rule out recurrence, and the remaining 16 cases required three or more operations to eradicate disease and reconstruct the hearing mechanism. Thirty-five (63%) of 56 patients had a postoperative air-conduction threshold pure-tone average (PTA) within 10 dB of the best bone-conduction PTA; 91% were within 20 dB. Average speech reception threshold improved from 32 dB hearing level (HL) preoperatively to 20 dB HL postoperatively.     

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。