改良的联合进路鼓室成形术治疗胆脂瘤型中耳炎

目的探讨改良的联合进路鼓室成形术治疗胆脂瘤型中耳炎的临床效果。方法对胆脂瘤型中耳炎83例行改良的联合进路鼓室成形术,同时用PORP或TORP行Ⅲ型听力重建,穿孔鼓膜用软骨-软骨膜复合物修补。所有病例随访2～5年,平均3.2年。结果所有83例患者在术后4～6周获得干耳,鼓膜愈合好,形态正常。但在术后半年有3例鼓膜出现中央性再穿孔,1.5年后有5例胆脂瘤复发(6.02%)。术后1年纯音听力,言语频率(500,1k,2k,3k,4kH2)气导较术前提高≥30dB者27例(32.53%),20～29dB者33例(39.75%),10～19dB者14例(16.87%),听力无改善者9例(10.84%)。结论改良的联合进路鼓室成形术治疗胆脂瘤型中耳炎具备完壁式和开放式鼓室成形术的优点,既获得良好的听力,又有低的胆脂瘤复发率。     

乳突根治加鼓室成形术临床疗效观察

目的：在传统乳突根治术的基础上，探讨保留部分外耳道后壁鼓室成形术的方法，以期提高化脓性中耳乳突炎病人的干耳率，提高听力的可能性，方法：对２６例（２９耳）化脓性中耳乳突炎患者进行乳突根治术，保留部分外耳道后上壁，一期重建中耳传音结构。结果：２６例（２９耳）术后８个月￣２４个月随访，术后干耳并听力提高达实用听力水平（２５ｄＢ以上）２６耳，治愈率达８９．７％，复发３耳，复发率为１０．３％。结论：对于耳咽管功能良好的化脓性中耳乳突炎病人的彻底清除乳突中耳病变的同时，行保留部分外耳道后壁及鼓环的鼓室成形术，更接近中耳生理结构，即清除炎性病变，又提高听力，值得推广。     

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.     

改良Ⅲ型鼓室成形术的远期疗效

采用改良Ⅲ型鼓室成形术的方法，以自体和同种异体肋软骨为听骨重建材料，完成鼓室成形术２６４耳。自体肋软骨柱１０２耳术后经５～６年随访，同种异体肋软骨柱１６２耳术后经４年以上随访，听力提高１５ｄＢ或达应用水平分别为７９耳（７７．４％）和１２４耳（７６．５％），术后远期听力效果较为满意。对该术式的特点进行了讨论。     

完整鼓室的乳突开放式鼓室成形术与开放式鼓室成形术的比较

目的探讨慢性中耳炎和胆脂瘤中耳炎手术方式及适应症的选择，比较完整鼓室的乳突开放式鼓室成形术与开放式鼓室成形术二种术式治疗慢性中耳炎的疗效。方法回顾性分析2005年1月-2007年5月期间97例（99耳），其中胆脂瘤中耳炎71耳，慢性中耳炎28耳，根据病灶范围选用完整鼓室的乳突开放式鼓室成形术（A组）22例（22耳）与开放式鼓室成形术（B组）75例（77耳）。对二组病例术前和术后纯音测听平均值PAT（500、1kHz、2kHz、4kHz）、气骨导差（ABG）等进行统计与比较。结果术后随访6个月～34个月，总干耳率93．9％（93／99），胆脂瘤复发率为7．0％（5／71）；术后气导（AC）提高值≥10dB为60．6％，气骨导差（ABG）≤20dB为29．3％；其中A组术后AC提高值≥10dB为90．9％，ABG≤20dB为54．5％；B组术后AC提高值≥10dB为51．9％，ABG≤20dB为22．1％。慢性中耳炎两组术后AC提高值及ABG经独立样本t检验，P〈0．05，具有统计学意义。结论完整鼓室的乳突开放式鼓室成形术较开放式鼓室成形术听力提高效果满意，干耳时间相似，但要选择适合病例。     

乳突根治加鼓室成形术临床疗效观察

目的 :在传统乳突根治术的基础上 ,探讨保留部分外耳道后壁鼓室成形术的方法 ,以期提高化脓性中耳乳突炎病人的干耳率 ,提高听力的可能性。方法 :对 2 6例 (2 9耳 )化脓性中耳乳突炎患者进行乳突根治术 ,保留部分外耳道后上壁 ,一期重建中耳传音结构。结果 :2 6例 (2 9耳 )术后 8个月～ 2 4个月随访 ,术后干耳并听力提高达实用听力水平 (2 5d B以上 ) 2 6耳 ,治愈率达 89.7% ,复发 3耳 ,复发率为10 .3%。结论 :对于耳咽管功能良好的化脓性中耳乳突炎病人在彻底清除乳突中耳病变的同时 ,行保留部分外耳道后壁及鼓环的鼓室成形术 ,更接近中耳生理结构 ,即清除炎性病变 ,又提高听力 ,值得推广。     

改良Ⅲ型鼓室成形术的远期疗效

采用改良Ⅲ型鼓室成形术的方法，以自体和同种异体肋软骨为听骨重建材料，完成鼓室成形术２６４耳。自体肋软骨柱１０２耳术后经５～６年随访，同种异体肋软骨柱１６２耳术后经４年以上随访，听力提高１５ｄＢ或达应用水平分别为７９耳（７７．４％）和１２４耳（７６．５％），术后远期听力效果较为满意。对该术式的特点进行了讨论。     

开放式鼓室成形术与改良乳突根治术联合治疗 慢性化脓性中耳炎的疗效分析

目的探讨和观察开放式鼓室成形术与改良乳突根治术联合治疗慢性化脓性中耳炎的临床治疗效果。 方法2010年6月～2015年6月收治慢性化脓性中耳炎患者120例,按随机数字表法分为观察组和对照组,对应随机数字为偶数者为观察组,奇数者为对照组,每组各60例。观察组患者采用开放式鼓室成形术与改良乳突根治术联合治疗,对照组患者只采用改良乳突根治术。结果观察组患者的临床治疗总有效率96.67%（58/60)优于对照组的75%（45/60),差异具有统计学意义（P＜0.05);观察组的干耳时间为（37.5±8.97）d,明显低于对照组的（49.2±10.97）d,差异具有统计学意义（P＜0.05);观察组患者经过治疗以后,听力较前有提高的患者为95%（57/60),明显高于对照组的86.67%(52/60),差异具有统计学意义（P＜0.05)。结论开放式鼓室成形术与乳突根治术在治疗慢性化脓性中耳炎的过程中解除中耳病变的速度较快,临床疗效明显,提高了患者的听觉能力。     

开放式鼓室成形术疗效观察

用开放式鼓室成形术治疗胆脂瘤型及非胆脂瘤型慢性化脓性中耳乳突炎51例、56耳,术后经1～5年随访,语言频率平均气导听力提高15dB以上44耳,占78.7%,干耳、鼓膜愈合良好53耳,占94.5%.对病灶清除操作要点及注意事项进行了讨论.     

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   

乳突切除术治疗分泌性中耳炎

目的：探讨乳突切除术治疗分泌性中耳炎的疗效。方法：回顾性分析22例（24耳）行乳突切除手术的分泌性中耳炎患者,其中行完壁式并面隐窝开放手术20耳,开放式手术4耳,同期行鼓膜切开置管术3耳。术后6个月拔管,测试术前、术后的听力。结果：所有患者术后均未出现听力下降,19耳有不同程度的听力提高,鼓室导抗图为A型曲线者17耳,C型曲线者7耳。术后随访6-36个月,未见中耳炎复发。结论：对反复发作、长期迁延经治疗无效的分泌性中耳炎,乳突切除术可改善乳突、鼓窦、鼓室和咽鼓管的通气引流,减少分泌性中耳炎的复发。     

The results of chronic ear surgery in a training programme

A retrospective study was undertaken of the results of surgery in a series of 782 patients with chronic otitis media. The recurrence rate of cholesteatoma was 20% of patients operated on by trainees and 12% operated on by the faculty. In ears with granulating otitis media, control of infection was achieved by trainees as often as by the faculty. The tympanic membrane healing rate of myringoplasty and tympanoplasty operations was 78% for trainees and 95% for the faculty (P < 0.001). Major surgical complications were relatively rare. It is concluded that the performance of trainees was fairly safe and better than expected, but some failures might have been prevented by closer supervision. Because of the decline in available patients for chronic ear surgery, it is suggested that the training programme should be restructured so that only those trainees who wish to pursue otological surgery as a career are trained in this field.     

Modified technique of tympanoplasty with functional results of 494 cases after 3 years*

This paper gives the functional preliminary and final results of tympanoplasty as modified by Khan¹ in types I-III in the form of a comparison. We examined 494 patients who were operated according to our modified technique. It is emphasized that in reconstruction of the middle ear, the use of a prepared fascial graft, homograft incus cartilage and external auditory meatal flap is sufficient. The preliminary and final results were documented with the aid of audiograms which were described and critically appraised according to two different types of evaluation. The evaluation did not only include the hearing results of tympanoplasty, but also the change in individual frequencies for all types. According to our appraisal of the operations with regard to social hearing the functional results of operations performed in our clinic may be considered above average. The hearing gain achieved from the preliminary postoperative control to the final examination is especially satisfying, since it also includes an improvement in bone conduction values.     

Pre- and post-operative clinical findings of tympanomastoid surgery in female divers (Haenyeo) of Jeju Island with chronic otitis media

Conclusions: A tympanomastoid surgery can control chronic otitis media (COM) and improve hearing effectively in Jeju women divers (Haenyeo) without any complications. Objective: To evaluate the long-term results of tympanomastoid surgery in Haenyeo patients with COM to determine any link between their diving behavior and COM. Methods: The medical records of 207 COM patients who underwent tympanomastoid surgery were reviewed for demographic characteristics, etiologic analyses, pre- and post-operative hearing levels, types of tympanomastoid surgery with ossiculoplasty, and post-operative complications. The patients were divided into a ‘Haenyeo COM group’ of 98 patients and a ‘general COM group’ of 109, and followed up for at least 3 years. Results: In the audiologic study, the Haenyeo COM group showed a relatively larger pre-operative air–bone gap than the general COM group. There were no statistically significant differences in middle ear swab culture results, the rates of re-perforation of the tympanic membrane or re-operation, or the risk of post-operative complications between the two groups. However, the possibility of COM accompanying cholesteatoma was higher and the canal wall down mastoidectomy was more frequently performed in the Haenyeo COM group (both p < 0.05).     

完壁式鼓室成形术治疗胆脂瘤型中耳炎的疗效观察

目的探讨完壁式鼓室成形术治疗胆脂瘤型中耳炎的临床效果。方法对胆脂瘤型中耳炎78例行完壁式鼓室成形术，并对手术方法和疗效进行分析。结果经1-5年随访，移植的颞肌筋膜愈合良好，完全成活70例，占89．74％，5耳鼓室腔内胆脂瘤复发致鼓膜穿孔，再次手术痊愈。3耳因移植物供血不良发生穿孔。术后1年纯音听力较术前提高≥30dB的为14例（17．95％），20—29dB的为32例（41．03％），10—19dB的为15例（19．23％），听力无改善者17例（21．79％）。胆脂瘤复发5例（6．41％）。结论完壁式鼓室成形术在清除中耳病灶和重建听力的同时，保存了耳部正常形态，提高了患者的生活质量。     

保留低位骨桥的开放式乳突根治并鼓室成形术65例临床分析

目的 回顾性分析近期本人施行的65例保留低位骨桥的开放式乳突根治鼓室成型手术。方法 回顾分析2003年1月-2004年3月本人实施的65例保留低位骨桥的开放式乳突根治鼓室成型手术病例，其中胆脂瘤型中耳炎41例．骨疡型中耳炎24例介绍其手术方法并对术后干耳率及听力提高情况进行了统计分析。结果所 有病人均获干耳．鼓膜愈合良好，无明显内陷。干耳时间约为1—3个月，术后随访1年，无一例胆脂瘤或中耳炎复发。干耳后的听力恢复较满意。平均气骨导差缩小在10dB以上共占83．6％，其中10—20dB占38．2％，20—30dB占30．5％，〉30dB者14．9％。结论 保留低位骨桥的开放式乳突根治术在治疗胆脂瘤型或严重骨疡型中耳炎中既能保证彻底清除病变又能最大限度提高患耳的听力．是治疗这类疾病一种较好的手术方法。