耳甲腔成形术在开放式乳突手术中的应用

目的 探讨耳甲腔成形术在开放式乳突手术中的应用价值.方法 对52例耳行耳甲腔成形术(成形组)及46例未做耳甲腔成形术(对照组)的患者进行疗效比较.结果 成形组术后干耳时间20.24d.肉芽生长发生率为7.69％,术腔感染再干耳时间7.25d.对照组干耳时间为32.61d.肉芽生长发生率为30.43％.术腔感染再干耳时间为12.34d.两组比较差异有统计学意义.两组术后复发,耳鸣及头晕的发生率差异均无统计学意义.结论 耳甲腔成形术操作简单,能有效改善术腔通气引流,缩短干耳上皮时间.值得在开放式乳突手术中应用.     

耳甲腔成形术在乳突根治术中的应用

目的：探讨耳甲腔成形术对乳突根治术疗效的作用。方法：对32例做耳甲腔成形术(成形组)及36例未做耳甲腔成形术(对照组)的乳突根治术进行疗效对比。结果：成形组干耳时间平均为5周，其中1例出现耳廓软骨膜炎，5例术腔内痂皮堆积，2例再感染。对照组干耳时间平均为9周，外耳道均较狭窄，乳突腔内痂皮易堆积，再流脓12例。结论：耳甲腔成形术能缩短乳突根治术的干耳时间，可提高疗效。术前的细菌培养和药敏试验及术后的随访是重要的。     

肌骨膜瓣填塞乳突腔、耳甲腔成形并一期鼓室成形术

目的观察对慢性化脓性中耳乳突炎(胆脂瘤或骨疡型)患者行耳后肌骨膜瓣填塞乳突腔、耳甲腔成形、WullsteinⅢ型鼓室成形术的手术疗效.方法采用耳后切口对37例(37耳)慢性化脓性中耳乳突炎(胆脂瘤或骨疡型)病人施行耳后肌骨膜瓣填塞乳突腔及耳甲腔成形和Ⅲ型鼓室成形术.结果术后听力平均提高16dB,26耳平均听力达35.8dB,9耳平均听力达25dB.跟踪随访2-4年,术腔均上皮化好,外耳道无痂皮堆积.26例鼓膜形态完全正常,5例鼓膜疤痕内陷,3例鼓膜穿孔但干耳,干耳率91.9%(34/37);3耳仍有间断性流脓,经再次手术干耳,2例胆脂瘤复发,复发率5.4%(2/37).干耳时间在5-9周,平均6.5周.结论耳后肌骨膜瓣填塞乳突腔、耳甲腔成形并Wullstein Ⅲ型鼓室成形术能使术腔迅速上皮化、易干耳,术后听力提高.     

耳甲腔外耳道成形在开放式乳突手术中的应用

目的：探讨耳甲腔成形在开放式乳突术中的应用价值。方法：80例慢性化脓性中耳炎患者行开放式乳突手术,其中38例行四瓣法耳甲腔成形（成形组）,42例未行耳甲腔成形（对照组）,对2组疗效进行相关分析比较。结果：成形组术后干耳时间为17．18d,肉芽生长发生率为5．26％（2／38）,术腔感染再干耳时间为4．58d;对照组干耳时间为25．50d,肉芽生长发生率为21．43％（9／42）,术腔感染再干耳时间为9．64d,2组比较均差异有统计学意义。2组术后复发、耳鸣及头晕的发生率差异均无统计学意义。结论：本文耳甲腔成形操作简单易行,能有效改善术腔通气引流,缩短干耳上皮化时间,清理方便,减少患者术后复诊次数,减轻随访难度及工作量,值得在开放式乳突手术中提倡应用。     

III型外耳道胆脂瘤手术治疗的术式选择

目的　探讨骨性外耳道后壁和乳突遭不同程度破坏的III型外耳道胆脂瘤的治疗选择及疗效。方法　收集44例（共45耳）临床诊断为III型外耳道胆脂瘤患者,根据乳突破坏程度的不同采用不同的术式进行手术：27耳乳突破坏未达鼓窦患者（A组）,采用单纯乳突修理+外耳道成形术+必要时行耳甲腔成形术治疗;18耳乳突破坏达鼓窦患者（B组）,采用乳突切开+乳突填充+外耳道成形+耳甲腔成形术治疗。结果　所有患者术后随访1～2年,均无胆脂瘤复发,无外耳道塌陷、狭窄或闭锁,听力有不同程度的提高。其中A组患者术后干耳率为100%,平均干耳时间（12.1±2.3）d,具有光滑外耳道以及良好自净作用的占100%;B组患者术后干耳率为94.4%,平均干耳时间（28.1±3.5）d,具有光滑外耳道以及良好自净作用的占88.9%。结论　III型外耳道胆脂瘤可根据乳突破坏是否达鼓窦而采用不同的术式：破坏未达鼓窦患者,采用单纯乳突修理+外耳道成形术+必要时行耳甲腔成形术;破坏达鼓窦患者,采用乳突切开+乳突填充+外耳道成形+耳甲腔成形术,疗效均显著。     

两种切口行耳甲腔成形术疗效分析

手术是治疗胆脂瘤型及骨疡型中耳炎的主要方法，临床常采用乳突根治术改良乳突根治术或乳突开放＋鼓室成形术治疗。为使乳突术腔能够早日上皮化，在完成乳突根治术、改良乳突根治术、鼓室成形术后通常还要做耳甲腔成形术。为了研究不同耳甲腔成形术对乳突开放后干耳的作用，     

耳甲腔成形及乳突腔充填术在乳突根治术中的应用价值

目的探讨耳甲腔成形术及乳突腔充填术在乳突根治术中的应用价值.方法25例、25耳行乳突腔充填术及耳甲腔成形术,分别于术后3、6个月观察乳突腔缩小情况、干耳时间、术腔上皮化及术后是否出现前庭症状等.结果经随访1～2年,患者巨大乳突术腔明显变小,皮肤光滑,色泽正常,全部病例均获干耳,干耳时间平均为6周,1例术后出现头晕,耳鸣症状,4耳同期行鼓室成形术,术后实用气导听力提高15～25dB.结论耳甲腔成形术及乳突腔充填术可以缩小乳突腔,促进乳突腔的通气引流及上皮化,提高乳突根治术的效果,同时有利于鼓室成形术.     

开放式乳突手术中改良乳突腔充填及耳甲腔成形术的应用

目的观察改良乳突腔充填及耳甲腔成形术对开放式乳突手术疗效的影响。方法 128例(130耳)胆脂瘤及慢性化脓性中耳炎患者经严格配对后分成改良组(65耳)和对照组(65耳),改良组在开放式乳突手术中应用改良的耳后肌骨膜行"S"形切开,分成蒂在乳突腔上下方的耳后肌骨膜瓣并加用乳突骨粉行乳突腔填充,且以耳甲腔"C"形切口形成蒂在下方的耳道耳甲腔大皮瓣完成耳甲腔成形术;对照组则在开放式乳突手术中采用传统乳突腔充填及耳甲腔成形术。结果改良组手术时间、术后干耳时间明显较对照组缩短,随访1~4年,改良组患者耳道口宽大,术腔痂皮堆积率明显少于对照组。结论开放式乳突术中应用改良乳突腔充填及耳甲腔成形术可缩短术后干耳时间,减少术腔痂皮堆积,提高手术效果。     

耳甲腔成形术在软骨环-软骨膜鼓室成形术中的意义

目的 观察对胆脂瘤中耳炎患者行乳突病变切除术、软骨环-软骨膜鼓室成形术同时行耳甲腔成形术的疗效.方法 胆脂瘤中耳炎患者77例,其中41例(41耳) (治疗组)采用耳后切口施行乳突根治术、软骨环-软骨膜鼓室成形术及耳甲腔成形术;对照组36例(36耳)采用耳后切口施行乳突根治术、软骨环-软骨膜鼓室成形术.分别于术后1个月、3个月、1年及 3 年追踪观察两组患者干耳情况并行纯音听阈检查,对结果行统计学分析.结果 治疗组术前气导平均听阈为45.66±8.40 dB HL,骨气导差为26.05±8.15 dB,术后3年气导平均听阈为23.55±7.10 dB HL,骨气导差为10.79±5.52 dB.平均干耳时间24.25± 5.37天,治愈率100%.未发生外耳道狭窄.对照组术前气导平均听阈为43.78±9.25 dB HL,骨气导差为25.65±8.55 dB,术后3年气导平均听阈为29.33±8.32 dB HL,骨气导差为17.10±6.62 dB,12例发生外耳道狭窄,其中有8例胆脂瘤复发,干耳时间32.35±15.60天.结论 乳突根治术+软骨环-软骨膜鼓室成形术同时行耳甲腔成形术能使术腔迅速上皮化、易干耳,术后听力提高,效果满意.     

开放式鼓室成形术或乳突根治术中切除乳突尖的优点

目的：总结乳突尖部分切除在开放式鼓室成形术或乳突根治术中的作用。方法：44例胆脂瘤型中耳炎患者中，行单纯乳突根治术(10例)和开放式鼓室成形术(34例，含乳突切除术加鼓室成形术Ⅱ型或Ⅲ型)时．同时切除部分乳突尖外侧壁。结果：切除乳突尖后，乳突容积明显减小，术后3个月随访，干耳43例，占97．6％。干耳时间3周～2．5个月。术后1年随访，无一例胆脂瘤复发。结论：乳突尖部分切除在开放式鼓室成形术或乳突根治术中消灭乳突死腔，最大程度达到干耳，减少胆脂瘤复发，具有重要作用。     

软壁外耳道重建的鼓室成形术

目的:观察软壁外耳道重建的鼓室成形术治疗胆脂瘤中耳炎的疗效。方法:73例(76耳)胆脂瘤中耳炎患者行开放式乳突病变切除鼓室成形术,以耳后肌骨膜瓣行软壁外耳道重建,不做耳甲腔成形术,应用自体乳突皮质骨或砧骨雕刻后行听骨链重建。观察术后外耳道的形态和功能、术后听力以及有无并发症。结果:本组平均干耳时间为术后(21.1±3.1)d。术后外耳道形态基本正常,保持了正常的功能。随访6～24个月,术后气导听力平均改善(14.5±6.1)dB HL。结论:应用耳后肌骨膜瓣行软壁外耳道重建的鼓室成形术能使外耳道的形态和功能基本恢复正常,无需行耳甲腔成形术,听力改善满意。     

急性化脓性耳廓软骨膜炎手术疗效分析

目的 探讨能够缩短化脓性耳廓软骨膜炎疗程,降低耳廓畸形发生率且具个体化的局部治疗方法.方法 回顾分析1 989年4月～2010年2月我科诊治的25例化脓性耳廓软骨膜炎的临床资料.除进行抗生素治疗外,局部治疗方法包括清创术后重新行耳甲腔成行术;脓腔穿刺置静脉留置针进行持续负压引流;清创后创腔置管引流.结果 自定义疗效评定...     

外耳道胆脂瘤并发化脓性腮腺炎1例并文献复习

目的 探讨外耳道胆脂瘤并发化脓性腮腺炎病因及诊治经验,并进行外耳道胆脂瘤诊疗相关文献复习。 方法 回顾性分析1例外耳道胆脂瘤并发化脓性腮腺炎病例资料,主要症状为左耳听力下降伴流脓,左侧面部红肿疼痛。颞骨CT及耳部核磁示:左侧外耳道内胆脂瘤形成,累及乳突、鼓室、鼓窦、腮腺及咽旁间隙。临床诊断:外耳道胆脂瘤(左,Holt Ⅲ期)、化脓性腮腺炎(左)。手术方式为左耳外耳道胆脂瘤切除术、开放式乳突根治术、鼓室成形术、人工听骨植入术、耳甲腔成形术、腮腺脓肿清除术及腮腺瘘修补术。 结果 术中彻底清除外耳道及中耳内胆脂瘤及腮腺脓肿,并修复腮腺瘘。术后随访患者恢复良好,无胆脂瘤复发残留及腮腺炎复发相关症状出现。 结论 外耳道胆脂瘤具有骨质破坏的潜能。而HoltⅢ期外耳道胆脂瘤并发化脓性腮腺炎病例罕见,明确病因并依据病变侵袭范围选择个体化的治疗方案尤为关键。     

Success of cartilage grafting in revision tympanoplasty without mastoidectomy.

OBJECTIVE: Candidates for revision tympanoplasty have experienced at least one failed attempt at repair of the tympanic membrane and are, therefore, at higher risk for subsequent repair failure. The adjunctive use of mastoidectomy with tympanoplasty in those patients with noncholesteatomatous chronic otitis media is often used to decrease the risk for subsequent failure. However, at this institution, where we use cartilage tympanoplasty, mastoidectomy is rarely performed in the absence of cholesteatoma. Our objective was to assess outcomes in patients undergoing revision tympanoplasty without mastoidectomy using cartilage grafting. STUDY DESIGN: We conducted a retrospective case review. SETTING: Tertiary referral center. PATIENTS: A total of 95 patients (42 female, 53 male; 5-81 yr of age) with a recurrent perforation who were treated surgically with cartilage tympanoplasty without mastoidectomy were included in the chart review. Patients must have undergone at least one previous tympanoplasty without mastoidectomy and had to have complete audiologic and chart follow up. INTERVENTIONS: An underlay tympanoplasty technique using either a tragal cartilage-perichondrium island graft or palisaded concha cymba cartilage was used. Ossiculoplasty was performed as needed. MAIN OUTCOME MEASURE: Main outcome measures were incidence of reperforation of the grafted tympanic membrane, hearing result, and prevalence of other complications. RESULTS: Successful closure without reperforation was obtained in 90 of 95 patients (94.7%). Average postoperative pure-tone average air-bone gap was 12.2 +/-7.3 dB compared with 24.6+/-13.8 dB preoperatively (p <0.001). CONCLUSIONS: Revision tympanoplasty with cartilage provided equivalent results to tympanoplasty with mastoidectomy. Thus, mastoidectomy may not be necessary in revision tympanoplasty in the absence of cholesteatoma if the repair is made with cartilage.     

耳后带蒂复合皮瓣移植填塞乳突术腔 并重建外耳道后壁

目的探讨陈旧性根治性乳突术腔填塞及外耳道后壁缺损的修复方法。方法采用耳后带蒂复合皮瓣移植,对10例(11耳)行乳突根治术后1～6年的患者,行陈旧性乳突术腔填塞及外耳道后壁缺损重建术,并同期行鼓室成形术。结果术后随访3～30个月,全部患者乳突术腔消失,外耳道大小接近正常;术后干耳时间2～3周,“根治腔病”症状明显好转,平均听阈下降13.6dBHL。结论本方法缩短了术后干耳时间,对乳突根治术后的“根治腔病”具有明显的治疗效果,有利于鼓室成形术。     

Preservation of the mastoid aeration and prevention of mastoid dimpling in chronic otitis media with cholesteatoma surgery using hyaluronate-based bioresorbable membrane (Seprafilm)

During mastoidectomy a hollow-cavity is formed within the mastoid bone after its cortex and air cells are removed. Postoperatively, the aerated cavity is usually filled with soft tissues. Also it is not so uncommon to see cases with retraction of the mastoid area skin into the cavity causing a cosmetic problem termed as mastoid dimpling. In order to achieve an aerated mastoid cavity and minimizing the mastoid dimpling, an adhesion barrier was utilized to prevent fibrous tissue formation within the cavity. Twenty-one patients with middle ear and/or mastoid cholesteatoma, who underwent tympanoplasty with mastoidectomy (canal wall-up) with staged procedures, were included in the study. The mastoid cavity was tented and covered with an adhesion barrier (hyaluranic acid and carboxymethylcellulose, Seprafilm, (Seprafilm, GENZYME Inc., Cambridge, MA, USA) at the end of the surgery. Postoperatively, in two cases serohemorrhagic fluid collected between the adhesion barrier membrane and the subcutaneous tissues requiring drainage. Second stages were performed 4–6 months after the first stage. Two residual cholesteatoma cases were present. Patients were followed for a minimum of 2 years after the second stage. Mean follow-up was 2 years and 5 months. No wound infection was encountered postoperatively. Late follow-up of minimum 2 years after the second surgery revealed cosmetically acceptable retroauricular area with no dimpling. Mild retraction in two cases and two micro-central perforations in the neotympanic membrane were found. CT scans obtained both prior to the second stage and at the end of the second year of second stage revealed fully aerated mastoid cavities covered with periosteum in its natural position. Mastoid cortex plasty with seprafilm offers a rapid and effective solution to the preservation of mastoid space and the preservation of the contours of the mastoid bone.     

改良Brent法全耳再造术治疗先天性小耳畸形的临床分析

目的 探讨改良Brent法全耳再造术治疗先天性小耳畸形的临床效果及经验。方法 选取2018年11月—2021年4月湖南省儿童医院耳鼻咽喉头颈外科收治的用改良Brent法全耳再造术治疗先天性小耳畸形的患儿20例，患儿均为单侧耳畸形，年龄6.5~15岁，平均年龄8.7岁。一期手术首先处理残耳，分离耳后乳突区形成囊腔，同时行耳垂转位。取患耳对侧的肋软骨雕刻成耳廓支架，在传统雕刻的基础上，同时雕刻出耳屏，将耳屏处的基底垫高，尽可能的加深耳舟、三角窝，耳屏、耳屏间切迹的深度，在修剪耳轮时，将耳轮脚的前端尽可能垫高，尖端留置的更长，以凸显耳轮脚的深度。将耳廓支架埋置于耳后囊腔内;二期手术行"立耳"，颅耳角成形;三期手术行耳甲腔成形。结果 20例再造耳一期手术出现血肿1例，二期手术出现感染1例，支架外露1例，通过局部处理均恢复，并继续进行下一期手术。所有患儿三期手术术后随访3~9个月，再造耳双耳对称性佳，耳轮脚、耳屏处形态佳，颅耳沟加深，耳垂与耳廓下部接合处的线条流畅，再造耳总体外观满意。结论 改良Brent法全耳再造术，可更凸显耳屏、耳轮脚、三角窝及耳垂等部位的细微结构，更能呈现出再造耳的立体感，该方法可为先天性小耳畸形手术方式的选择提供参考。     

Repair of the auricular area after petrosectomy]

The authors report a retrospective series of 12 patients presenting periauricular tumors having invaded the external auditory canal and concha: 5 squamous cell carcinomas, 3 basal cell carcinomas, 2 Darrier-Ferrand sarcomas, 1 parotidean adenocarcinoma, 1 radionecrosis. The operation included an extralabyrinthic petrosectomy, an amputation of the pavilion, and a ganglionic evidement following a histological analysis. The reconstruction processes used 3 pedicle grafts and 9 free grafts. The carcinological extension modalities of the cancers invading the entire external auditory canal require the sacrifice of the tympanic cavity and an external temporalectomy in a single block for carcinological and functional reasons. The massive invasion of the concha inevitably leads to the sacrifice of the auricular pavilion. The best means of reconstruction is with the free graft of the musculus latissimus dorsi. The price to be pay esthetically must be reduced by the placement of an epithesis.     

Mastoid obliteration and reconstruction techniques: A review of the literature

ObjectiveTo review the published literature related to the different obliteration and reconstruction techniques in the management of the canal wall down mastoidectomy.MethodsA PubMed (Medline) and LILACS databases as well as crossed references search was performed with the following Mesh terms: “cholesteatoma”, “cholesteatoma-middle ear”, “otitis media”, “otitis media, suppurative”, “mastoiditis”, “mastoidectomy”, “canal wall down mastoidectomy”, “radical mastoidectomy”, “mastoid obliteration” and crossed references. Inclusion criteria were adult patients subject to mastoid cavity obliteration and posterior canal wall reconstruction. The technique and materials used, anatomic and functional results, complications, recurrence rates, and changes in quality of life, were analyzed. A total of 94 articles were screened, 38 were included for full-text detailed review.ResultsTwenty-one articles fulfilled the inclusion criteria. Techniques and materials used for canal wall reconstruction, tympanoplasty, and ossiculoplasty were varied and included autologous, biosynthetic, or both. Auditory results were reported in 16 studies and were inconsistent. Three studies reported improvement in the quality of life using the GBI scale. Follow-up time ranged from 1 to 83 months. Eleven articles used imaging studies to evaluate postoperative disease recurrence. The highest recurrence rate reported for cholesteatoma after obliteration was 19%. The most frequently reported complications were retraction pockets and transient otorrhea.ConclusionPlenty of techniques combining grafts and other materials have been used to overcome mastoidectomy cavity problems. So far, it is still not possible to standardize an ideal procedure. The available level of evidence for this topic is low and limited.     

A technique for concurrent procedure of mastoid obliteration and meatoplasty after canal wall down mastoidectomy

Objective

To present a simple technique for concurrent procedure of mastoid obliteration and meatoplasty after canal wall down mastoidectomy, and to assess the efficacy and the surgical results of this technique.

Methods

Retrospective clinical study of a consecutive series of procedures from 2004 to 2008. One hundred thirteen patients undergone canal wall down mastoidectomy with tympanoplasty and concurrent procedure of mastoid obliteration and meatoplasty that uses an anteriorly based musculoperiosteal flap and a horizontal skin incision on the concha were included. Preoperative diagnoses were classified into cholesteatoma, adhesive otitis media, and chronic suppurative otitis media. The mean duration of follow-up was 38 months, with a range of 12–75 months. We analyzed control of suppuration and creation of a dry mastoid cavity according to the Merchant's grading system for evaluation of the efficacy of this technique, and hearing outcome. We evaluated postoperative complications including development of recurrent or residual cholesteatomas and duration of the mastoid cavity achieving a complete healing.

Results

Seventy-two patients had cholesteatoma, whereas 27 patients had adhesive otitis media and 14 patients had chronic suppurative otitis media. Eighty-three percent of all patients, in 86% of patients with cholesteatoma, in 78% of patients with adhesive otitis media, and in 78% of patients with chronic suppurative otitis media were achieved a dry and self-cleaning mastoid and complete control of infection. Duration of the mastoid cavity achieving a dry and self-cleaning mastoid ranged from 4 weeks to 24 weeks and the mean time of the complete epithelialization was 11.1 ± 4.6 weeks. The average ABGs were 32.4 ± 13.8 dB preoperatively and 23 ± 13.2 dB postoperatively. There were 5 patients with failure of control of infection postoperatively and 3 patients of recidivistic cholesteatoma.

Conclusion

The efficacy of our technique to make a dry and healthy mastoid cavity after a canal wall down mastoidectomy is satisfactory, and the rate of complication is acceptably low. We believe that our technique could be a convenient method to prevent cavity problems after canal wall down mastoidectomy.