Impact of mastoidectomy on simple tympanic membrane perforation repair

OBJECTIVES/HYPOTHESIS: Mastoidectomy has long been identified as an effective method of treatment for chronic ear infection. The effect of mastoidectomy on patients without evidence of active infectious disease remains highly debated and unproven. The objective in the study was to examine the impact of mastoidectomy on the repair of uncomplicated tympanic membrane perforations. STUDY DESIGN: Retrospective study of patients at tertiary referral center. METHODS: Four hundred eighty-four patients who underwent surgical repair of simple tympanic membrane perforations were identified and reviewed in a retrospective manner. Simple tympanic membrane perforations were defined as tympanic membrane perforations of any size and location without any of the following confounding variables: 1). active infection (active otorrhea, abnormal middle ear mucosa, or granulations tissue); 2). ossicular abnormalities (ossicular fixation, ossicular discontinuity, ossicular malformation, or ossicular absence); 3). cholesteatoma; or 4). prior attempt at tympanic membrane repair (prior tympanoplasty or mastoidectomy). Surgical outcome and clinical course were assessed to compare results of tympanic membrane perforation repair with and without canal wall up mastoidectomy. RESULTS: Tympanic membrane repair was equally effective in both groups at 91%. Hearing results were comparable. Development of persistent ipsilateral otological disease requiring a subsequent ipsilateral procedure was approximately twice as common in the tympanoplasty group. In the tympanoplasty group, 14.1% of patients underwent subsequent ipsilateral otological procedures, and 6.1% of patients in the tympanoplasty with mastoidectomy intact canal wall group underwent subsequent ipsilateral procedures (P <.05). The most common subsequent ipsilateral procedures were tympanoplasty, tympanostomy tube placement, tympanoplasty with mastoidectomy canal wall up, and tympanoplasty with mastoidectomy canal wall down, in that order. After including untreated tympanic membrane perforations as subsequent procedures, the adjusted rate of subsequent procedures was 15.5% in the tympanoplasty group and 12.2% in the tympanoplasty with mastoidectomy group (P >.05). CONCLUSION: Mastoidectomy was not necessary for successful repair of simple tympanic membrane perforations. However, mastoidectomy impacted the clinical course in patients by reducing the number of patients requiring future procedures and by decreasing disease progression. This suggests that even in the absence of active evidence of infection, mastoidectomy improved the underlying disease process. Combining mastoidectomy with tympanoplasty during repair of simple perforations in patients with no active evidence of infection remains an appropriate option and may be valuable in reducing the need for future surgery.     

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。     

Candidate's thesis: Revision tympanoplasty utilizing fossa triangularis cartilage

OBJECTIVES/HYPOTHESIS: A small percentage of fascia graft tympanoplasties fail. Cartilage tympanoplasty has a reputation for excellent graft healing but potentially sacrifices maximum hearing improvement and creates difficulty in postoperative follow-up resulting from opacity and immobility. We sought to use a tissue thicker than fascia but thinner than tragal cartilage to repair tympanic membranes that had failed previous fascia grafting. Our hypothesis was that use of the thinner cartilage would maintain the excellent healing rate and resistance to chronic negative pressure while improving hearing and mobility. STUDY DESIGN: The study is a retrospective review of all patients who received a total cartilage graft tympanoplasty after experiencing a failed standard fascia graft tympanoplasty. No previous operative series on impedance testing following cartilage grafting was identified in the literature. Standard audiologic and tympanometric parameters were obtained in all patients. METHODS: Tragal and fossa triangularis cartilage were statistically analyzed for thickness and weight. Surgical indications included patients who had chronic otologic disease that resulted in recurrent tympanic membrane perforation, atelectasis, or cholesteatoma. The tympanic membrane and any posterior canal wall defect were completely replaced with cartilage. Preoperative and postoperative audiometric and impedence tympanometry measurements were compared. RESULTS: Triangularis fossa cartilage is thinner and has less mass than tragal cartilage. Complete data were obtained on 83 of 159 patients to make up this study. The success rate for tympanic membrane integrity measured by tympanometry was 100% at a minimum 2-year follow-up in all ears included in the study. Hearing results are reported collectively and include all types of ossiculoplasty. The largest closure of air-bone gap was at 1000 Hz, followed by 2000, 500, and 4000 Hz. The patient's best hearing level was most frequently at 2000 Hz. Impedence testing showed a large shift in tympanogram configuration from B to C, indicating that cartilage grafts heal with integrity and measurable mobility although stiffened compared with normal. CONCLUSIONS: Fossa triangularis cartilage is thinner and has less mass than tragal cartilage. This creates a relatively mobile neotympanic membrane that can be monitored postoperatively by standard tympanometry, and allows for excellent hearing results. Recurrent tympanic membrane perforation or atelectasis with or without bony canal erosion that has failed standard fascia graft tympanoplasty can be successfully repaired with fossa triangularis cartilage graft tympanoplasty. Primary surgical use of cartilage graft tympanoplasty should be considered in patients with high-risk otologic disease, since fossa triangularis cartilage is thick enough to resist prolonged negative middle ear pressure and the hearing results with fossa triangularis cartilage shield graft tympanoplasty are comparable to those reported with fascia grafting. In patients with type A or C tympanogram results following successful fossa triangularis cartilage grafts, standard impedance testing can be used to clinically evaluate tympanic membrane mobility and help identify the presence of middle ear disease. However primary placement of a tympanostomy tube should be performed in patients with granulation tissue in the middle ear at time of tympanoplasty. Further study is needed to determine the ideal thickness of cartilage for tympanic membrane reconstruction.     

咽鼓管置管术在各种鼓室成形术中的应用

目的 :探讨咽鼓管置管术在各种鼓室成形术中的应用及疗效。方法 :对按不同方式进行听骨链重建、鼓室成形术的 71耳患者术中同时行咽鼓管置管术。结果 :除 5例继发鼓膜穿孔、术后流脓外 ,余均一次手术成功 ,未见再穿孔。手术失败与不同病种、不同术式间的差异无显著性意义。结论 :咽鼓管置管术对防止咽鼓管再粘连有效。     

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.     

Cartilage palisade tympanoplasty

Recurrent tympanic membrane perforations are usually caused by underlying conditions such as an adhesive process with a poorly aerated middle ear space, a thermal perforation, infection, or technical error at the time of graft placement. Despite surgical treatment these reperforations pose a significant otologic problem that may lead to the development of chronic otitis media and cholesteatoma. The purpose of this study is to detail the use of a new cartilage palisade tympanoplasty technique that has yielded a 100% tympanic membrane closure rate without recurrent perforations in 52 operated ears over a 2-year period. The acoustic properties of the rebuilt tympanic membrane were analyzed for types I, II, and III tympanoplasty and revealed a significant improvement in the postoperative air bone gap.     

Over-under tympanoplasty

OBJECTIVE: Common techniques of tympanic membrane repair include underlay and overlay grafting. The over-under tympanoplasty, an innovative method for tympanic membrane repair, will be described as a reliable alternative that has advantages over traditional procedures. STUDY DESIGN: This study was a retrospective case review. SETTING: Tertiary referral center with hospital-setting surgery and outpatient ambulatory patient visits. PATIENTS: One hundred twenty patients who underwent over-under tympanoplasty were included in this study. Average follow-up was 1.8 years. INTERVENTION: Over-under tympanoplasty is performed by placing the graft over the malleus and under the annulus. This technique was used for patients undergoing ear surgery for chronic otitis media, perforations, cholesteatoma, and/or conductive hearing loss. All degrees of ear pathology were included. MAIN OUTCOME MEASURES: Main outcome measures were graft success (no perforation, atelectasis, or lateralization within 6 mo) and improvement of hearing. Patients were stratified by severity of disease (according to the Middle Ear Risk Index), cholesteatoma presence, and type of mastoidectomy. RESULTS: All 120 patients had successful grafts. Lateralization of the grafted drum did not occur. Seventeen patients had late atelectasis, and 12 patients had late perforations; nearly all of these were noted more than 1 year after surgery and were attributed to persistent eustachian tube dysfunction or infections. Average improvement in air-bone gap for all patients was 5.3 dB, whereas speech reception threshold improved by 5.9 dB. CONCLUSION: Over-under tympanoplasty has an excellent success rate while being technically easier than lateral tympanoplasty. Thus, it is a useful method for practitioners of all levels.     

Congenital Cholesteatomas in the Tympanic Membrane

The etiology of congenital middle ear (ME) cholesteatomas is unclear. One etiologic possibility of ME cholesteatoma may be progression of a congenital tympanic membrane (TM) cholesteatoma. We recently have encountered three cases of congenital tympanic membrane cholesteatoma. Each child, ages 1, 3, and 14 years, presented with cholesteatoma of the tympanic membrane extending into the middle ear. These children have not had previous otologic surgery including myringotomy, nor had they had repeated middle ear infections, perforation, or trauma. Neither the 3-year-old nor 14-year-old child complained of hearing loss. Audiograms demonstrated only a mild conductive loss. Each child underwent excision with tympanoplasty. Although the middle ear component of the cholesteatoma was always more extensive than the pearl seen, the point of attachment was the TM and not the middle ear. This demonstrates one possible source for congenital cholesteatomas.     

Eustachian tube function related to the results of tympanoplasty in children.

The results of tympanoplastic surgery to repair a perforation of the tympanic membrane are less satisfactory in children than in adults. This paper reports the results of a propspective study of 45 children (51 ears) which was undertaken to determine which, if any, detectable and controllable pre or intraoperative parameters might predict the outcome of tympanoplasty surgery. A "successful" tympanoplasty was defined as that in which the initial graft took, in which the tympanic membrane remained intact, and which was not associated with high negative middle ear pressure, otitis media with effusion, or cholesteatoma during a follow-up period of one to two years. Assessment of hearing related to the tympanoplastic surgery was not included as an outcome measure. With this criteria, the overall success rate of tympanoplasty in children was 35%. The success of tympanoplasty was not related to graft placement, although the laterally placed grafts had a higher take rate (67%) than grafts placed medially (49%). Preoperative measures, such as the assessment of Eustachian tube function using the modified inflation-deflation test and tympanometric evaluation of the contralateral ear, failed to predict the success of tympanoplasty. Tympanoplasty universally failed in the ears in which an acquired cholesteatoma was present. Children remain uncertain candidates for tympanoplasty surgery since, as a group, their Eustachian tube function is not as good as that of adults.     

乳突鼓室成形手术的分期问题

目的探讨分期乳突鼓室成形术在以提高听力为目的的功能性耳显微外科中的作用.方法本文总结了海军总医院1993-2003年3月2700例各类中耳手术中分期鼓室成形术102例,随访1～5年,手术主要类型为保留外耳道后壁的乳突切开鼓室成形术、切除外耳道后壁的乳突切开鼓室成形术,保留骨桥的乳突切开鼓室成形术,文中对分期手术的理念、适应症选择、手术方式选择及移植筋膜感染、不愈合等问题进行了分析.结果 102例分期手术中,85例(83.3%)愈合良好,其中7例一期术后干耳,但二期手术中发现后鼓室及鼓窦处胆脂瘤珠及肉芽组织;17例存在不同程度的问题,出现率16%,包括一期术后出现移7植物穿孔或延迟愈合,在后鼓室、鼓窦、面神经隐窝等处发现胆脂瘤肉芽组织,但鼓室粘膜有不同程度的修复.102例分期手术术后1年气导听力(O.5K、1k、2k平均听力)较术前提高15 dBHL.结论在彻底清除病灶基础上,合理而有计划的行分期手术修复鼓室粘膜,恢复中耳含气空腔,为听骨链重建创造条件,以提高听力,不失为较佳的选择.     

Functional plastic surgery of inflamed cavities: the fascination of tympanoplasty

Reconstructive middle ear surgery was introduced in the early fifties. Kley was one of the first to investigate the applicability of grafts and the functional restoration of the middle ear transformer. He also practiced a combined approach with anterior tympanoplasty and posterior mastoidectomy. On the occasion of his 65th birthday it can be said that his achievements such as the use of fascia for tympanic membrane reconstruction, the systematic stapes elevation etc. have contributed to the success of tympanoplasty.     

Pathology as it relates to ear surgery. VII. Tympanoplasty

The surgical anatomy and pathology of the middle ear have been reviewed in relation to tympanoplasty. The results of tympanoplasty in providing a disease-free and functional middle ear varies widely with the pathology involving the eardrum, ossicles, mucoperiosteum, mastoid air cells and eustachian tube. Post-tympanoplasty changes in the eardrum graft, ossicular grafts, and middle ear have been described in six cases which underwent surgery one to eleven years before death. Proper understanding of the pathophysiology of the different diseases of the middle ear is mandatory in planning tympanoplastic procedures. The causes of graft failure and of post-operative conductive hearing loss are discussed and the ways to avoid technical complications are emphasized.     

Areolar temporalis fascia: a reliable graft for tympanoplasty

OBJECTIVE: This study examines the success rate of areolar temporalis fascia (fool's fascia) as a graft material for tympanoplasty. DESIGN: This study is a retrospective review of surgical cases. SETTING: This study was conducted at Kaiser Permanente Medical Center, San Diego, a tertiary referral center for otologic surgery within Southern California Permanente Medical Group. PATIENTS: Four hundred six patients having undergone tympanoplasty (with and without mastoidectomy) from September 1992 to December 1997 were observed. Medial graft (underlay) techniques were used in all cases, including total drum replacement procedures. Sixty-three percent (256/406) of the cases were revision surgeries. Seventy-three percent (296/406) of the cases were for total drum replacement. In 342 (84%) cases, areolar temporalis fascia was used as the graft material. OUTCOME MEASURE: Successful tympanic membrane healing. Failure of a graft was considered to be reperforation during the entire period of follow-up (range 6 months-5 years). RESULTS: Tympanic membrane healing was successful in 98.54% (337/342) of the cases in which areolar temporalis fascia was used as the graft material. Graft failure for other graft materials was slightly higher. Overall success rate for all 406 cases was 97.5%. CONCLUSIONS: Areolar temporalis fascia is an effective and reliable graft material for primary and revision tympanoplasty. Areolar fascia is readily found in most revision surgeries. Revision tympanoplasty achieved a success rate better than 95%.     

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.     

中耳胆固醇肉芽肿手术治疗策略探讨

目的:探讨中耳胆固醇肉芽肿手术治疗的策略。方法:对19例中耳胆固醇肉芽肿患者的临床资料进行回顾性分析。其中4例行单纯鼓膜置管术,8例行完壁式乳突切除+后鼓室切开+鼓膜置管术,7例行开放式乳突切除+鼓膜置管术。结果:术后随访0.5～3.3年。4例行单纯鼓膜置管术的患儿中,2例术后复发;8例行完壁式乳突切除+后鼓室切开+鼓膜置管术的患者中,3例术后复发;7例行开放式乳突切除+鼓膜置管术的患者无一例复发。在目前情况良好的14例患者中,有12例患者听力较术前明显改善。结论:对初发、病变范围局限的青少年患者,术前应完善检查以排除咽鼓管机械性阻塞因素,可选择单纯鼓膜置管术,术后定期观察;对症状反复发作、单纯置管或完壁式乳突切除+后鼓室切开+鼓膜置管术无效、病程较长或病变范围广泛的患者,应选择做保留鼓室完整性的开放式乳突切除+鼓膜置管术。     

中耳胆固醇肉芽肿的诊断与手术治疗

目的探讨中耳胆固醇肉芽肿的诊断与手术治疗方法。方法分析14例（15耳）经手术并病理证实的中耳胆固醇肉芽肿患者的病例资料。其中,行完壁式乳突根治加鼓室探查加中耳置管术6耳;完壁式乳突根治加听骨链重建6耳;改良乳突根治加鼓室成形3耳。结果1耳改良乳突根治加鼓室成形术后仍间断溢液;1耳中耳置管术后2周通气管脱落,中耳积液复发,需通气管重新置入半年病情缓解后取出。所有病例术后随访0．5～3年,14耳术后语频听力提高15dBHL以上,1耳术后听力无改变。结论中耳胆固醇肉芽肿应及早手术治疗。根据病变的程度、部位及范围,采取不同的手术方法。原则是彻底清除病变,建立咽鼓管、鼓室、鼓窦、乳突的通气系统。     

Butterfly cartilage graft inlay tympanoplasty for large perforations

OBJECTIVE: Butterfly graft inlay tympanoplasty is a well-established technique for the repair of small perforations. However, the efficacy of the technique for medium and large tympanic membrane perforations remains unknown. STUDY DESIGN: Retrospective case series. METHODS: Postauricular tympanoplasty and tympanomastoidectomy using a large butterfly cartilage inlay graft (>4 mm diameter to total drum replacement) were analyzed in 90 pediatric patients (99 ears). RESULTS: Patient ages ranged from 2 to 20 years; mean follow-up duration was 27.6 months. Successful closure occurred in 92% of the ears. No graft lateralized nor displaced into the middle ear. No retraction pocket occurred during the follow-up period. In 62 cases, intact canal wall or canal wall window tympanomastoidectomy was performed; Fifty-one (82.2%) of the patients having mastoidectomy procedures had chronic otitis media with cholesteatoma. The mean preoperative to postoperative four-tone air-bone gap improved from 23 to 21 dB; the number of patients with 0 to 10 dB hearing results increased from 16 ears preoperatively to 32 ears postoperatively. Postoperative suboptimal results included eight patients with postoperative perforations in the residual tympanic membrane adjacent to an intact cartilage graft; two of these patients were the only individuals who exhibited otorrhea. CONCLUSIONS: Cartilage butterfly graft inlay tympanoplasty is effective in the vast majority of patients with moderate to large perforations. The closure rate exceeded 90% with no graft displacement, postoperative adverse events were respectably low, and hearing results improved or remained stable despite the need for concurrent mastoidectomy in the majority of patients.     

Role of the mastoid in tympanic membrane reconstruction

Otologists have long debated the importance of the mastoid in determining the success or failure of tympanic membrane reconstruction. The pneumatic spaces within the mastoid represent an "air reservoir" which can be drawn upon during periods of eustachian tube dysfunction and buffer the middle ear against the development of detrimental negative pressures. Mastoid inflammatory disease, if untreated, may result in recurrent suppuration and graft failure. Small mastoid volume, aside from its well known association with chronic infectious middle ear disease, has been shown to effect adversely graft survival following myringoplasty. In 48 patients undergoing myringoplasty with simple mastoidectomy, neither small mastoid size nor inflammatory mastoid disease significantly decreased the rate of graft healing. This suggests that simple mastoidectomy is an effective means of repneumatizing the mastoid and eradicating mastoid sources of infection. The successful surgical creation of a pneumatized mastoid cavity in communication with the middle ear was confirmed by postoperative computerized tomographic (CT) scans. In failed cases, CT scanning predictably identified residual mastoid disease. Simple mastoidectomy is considered to be a safe and useful adjunct to myringoplasty in selected cases of chronic otitis media with perforation.     

中耳手术中鼓索神经的保护与效果分析

目的 探讨中耳手术中鼓索神经的处理方法及保护鼓索神经的可行性和必要性.方法 以2013年9月~2016年3月行中耳手术的155例(155耳)患者为研究对象,男86例,女69例,年龄19~65岁,平均38.23±5.7岁;其中,鼓室成形术 I型 24例,上鼓室切开+鼓室成形术I型6例,上鼓室切开+鼓室成形术II型 22例,完壁式乳突切开+鼓室成形术 23例,开放式乳突切开+鼓室成形术 74例,镫骨底板钻孔+活塞人工镫骨植入术 6例,均记录手术中鼓索神经显露和保护的方法,并观察患者术后3天和术后1月时同侧舌的味觉.结果 155例中,12例术中未暴露鼓索神经,126例术中完整保留之,故鼓索神经保存率为89.03%(138/155),鼓索损伤的17例中15例(88.2%,15/17)术后3天和术后1月时舌味觉减退;鼓索神经保护完整的126例中13例(10.3%,13/126)术后3天味觉减退,均于术后1个月内自行恢复;1例在术后16天发生迟发性面瘫,经糖皮质激素治疗2周后完全恢复.在鼓索神经保护完整与术中鼓索神经断裂这两部分病例间术后3天和术后1个月时味觉异常发生率差异均有统计学意义(χ2=57.753,P=0.000;χ2=124.2,P=0.000).结论 根据鼓索神经的走行位置和显露方式不同,在中耳手术中采取个体化的措施保护鼓索神经是可行的,可使患者术后味觉功能保持良好.