外科手套膜片贴补治疗外伤性鼓膜穿孔85例疗效观察

目的观察外科手套膜片贴补治疗外伤性鼓膜穿孔的疗效,探寻一种用于鼓膜穿孔贴补治疗的有效方便的新材料。方法 85例（87耳）外伤性鼓膜穿孔患者随机分成治疗组43例（44耳）和对照组42例（43耳）,2组均予抗生素预防感染。治疗组在此基础上,用橡胶外科手套修剪的贴膜贴补治疗穿孔鼓膜,7d复诊一次观察并比较2组鼓膜穿孔愈合情况及听力提高程度。结果治疗组治愈率为93%,对照组为65%,2组比较差异有统计学意义（P〈0.01）。治疗组穿孔愈合时间明显短于对照组（P〈0.01）。听力提高程度相当（P〉0.05）。结论用外科手套膜片贴补治疗外伤性鼓膜穿孔疗效好、愈合快,无明显不良反应,是较为理想的治疗材料。     

慢性化脓性中耳炎的综合治疗研究

目的分析碱性成纤维细胞生长因子(basic fibroblast growth factors,bFGF)在修复慢性化脓性中耳炎鼓膜穿孔中的作用.方法回顾分析经乳突X线片或CT、 MRI 及纯音测听等临床检测诊断为慢性化脓性中耳炎65例、82耳的临床资料,40耳用 bFGF 配合治疗与42耳未用 bFGF 治疗作为对照.结果bFGF 治疗组40耳中鼓膜完全愈合31耳,治愈率77.50%,对照组42耳中鼓膜完全愈合24耳,治愈率57.14%.两组差异有显著性(P＜0.05).治疗组31耳完全愈合平均所需时间为31.9d,对照组24耳完全愈合平均所需时间为45.5d(P＜0.05).结论bFGF 有助于修复炎症性鼓膜穿孔,能提高治愈率,并可加速愈合,缩短修复时间.     

左氧氟沙星滴耳液棉球贴补治疗外伤性鼓膜穿孔的临床疗效

目的探讨左氧氟沙星滴耳液棉球贴补治疗外伤性鼓膜穿孔的临床应用及治疗效果。方法外伤性鼓膜穿孔118例（124耳）,随机分为实验组76例（80耳）和对照组42例（44耳）,实验组予以左氧氟沙星滴耳液棉球贴补治疗,对照组采用传统自然愈合法治疗,定期随访,观察并记录鼓膜愈合情况及愈合时间。结果所有患者随访观察1个月,实验组80耳愈合77耳,愈合率为96.25%,对照组44耳愈合24耳,愈合率为54.55%,二者差异有统计学意义（χ2=32.680,P〈0.01）。实验组平均愈合时间为（15.35±4.562）d,对照组平均愈合时间为（20.45±4.501）d,两者经比较差异具有统计学意义（t=-4.804,P〈0.01）。实验组所有鼓膜愈合后与正常鼓膜接近,未出现任何不良反应。结论左氧氟沙星滴耳液棉球贴补治疗外伤性鼓膜穿孔,可提高鼓膜愈合率,缩短鼓膜愈合时间,取材方便,价廉,操作简单。     

鼓膜成形术治疗外伤性鼓膜穿孔的临床意义(附52耳报告)

目的:探讨鼓膜成形术治疗外伤性鼓膜穿孔的临床意义.方法:78例患者(80耳)中男48例,女30例,11～64岁,平均32.4岁,随机分为两组.鼓膜成形术组50例(52耳),鼓膜穿孔后1周内使用素高捷疗眼膏浸渍棉片贴补,对照组保守治疗.结果:鼓膜成形术组鼓膜平均愈合时间11.5d,愈合率为100%,对照组15.4d,愈合率92.8%,差异有显著性(P<0.05).鼓膜成形术组未发生继发感染,对照组6耳继发感染,差异有显著性(P<0.05).结论:鼓膜成形术治疗外伤性鼓膜穿孔可缓解症状,提高听力,减轻患者痛苦,促使鼓膜早期愈合,避免继发感染,操作简便,安全有效.     

沙棘油治疗外伤性鼓膜穿孔的临床观察

我科自１９９７年以来用沙棘油修补外伤性鼓膜穿孔，能促进鼓膜愈合，疗效显著，现报告如下。1 资料与方法1．１ 一般资料1９９７年以来共治疗外伤性鼓膜穿孔６０例（６６耳）。随机分为２组，Ａ组（沙棘油组）３０例（３４耳），男１７人，女１３人；Ｂ组（生理水盐组）３０例（３２耳），男１９人，女１１人。两组贴补修复开始时间均为就诊时间。根据芽孔直径（电耳镜下目测穿孔中央处距离）分为Ⅰ°＜３ｍｍ，Ⅱ°介于３ｍｍ～６ｍｍ，Ⅲ°＞６ｍｍ之间。两组病情分布情况见表 １；平均年龄、平均就诊时间、语言频率气导平均阈值（下简称…     

鼓膜出血程度对外伤性鼓膜穿孔预后的影响

目的研究鼓膜出血程度对外伤性鼓膜穿孔预后的影响。方法72例（72耳）女性外伤性鼓膜穿孔患者根据其伤时鼓膜出血程度分为A、B两组,A组38例,伤时耳道或鼓室积血、鼓膜出血面积占残余鼓膜的1／3以上,B组耳道或鼓室无血液、创缘仅少量充血,鼓膜出血面积小于残余鼓膜的1／3。两组均给予明胶海绵贴补处理,观察穿孔愈合情况。结果3周内A组愈合33例,愈合率86．84％（33／38）,愈合时间13．2&#177;2．9天;B组愈合19例,愈合率55．88％（19／34）,愈合时间22．1&#177;3．6天,A组比B组穿孔提前愈合9天左右,A、B两组之间存在统计学差异（P〈0．01）。结论外伤性鼓膜穿孔预后与伤时鼓膜出血程度密切相关,伤时鼓膜出血愈重,穿孔愈合时间愈短。     

耳后进路-夹层法鼓膜成形术（附285例疗效分析）

目的分析慢性化脓性中耳炎及外伤性鼓膜穿孔患者行耳后进路-夹层法鼓膜成形术后的疗效。方法回顾性分析285例（308耳）行耳后进路-夹层法鼓膜成形术患者的临床资料。结果术后随访281耳（91．23％）鼓膜愈合，287耳（93．18％）术后气骨导差值在15dBHL以内；213耳术后气骨导差缩小≥15dBHL（包括15dB）听力提高69．16％，21耳术前、术后气骨导差值未改善（仍在15-30dBHL之间），占6．82％。无耳鸣、面瘫等严重并发症出现。结论慢性化脓性中耳炎和外伤性鼓膜穿孔患者行耳后进路-夹层法鼓膜成形术后鼓膜愈合率高，多数患者听力改善。     

外伤性鼓膜穿孔患者常频与扩展高频测听结果分析

目的探讨外伤性鼓膜穿孔对扩展高频听力的影响。方法对55例（55耳）外伤性鼓膜穿孔患者在鼓膜愈合前后行常频纯音测听及扩展高频测听,骨导频率范围0.25～4kHz,气导频率范围0.125～16kHz,并与30例（60耳）健康对照组比较。结果在常频段,外伤性鼓膜穿孔患者鼓膜穿孔时所有频率气、骨导阈值均高于对照组,差异有统计学意义（P〈0.05）,鼓膜愈合后气、骨导阈值与对照组比较差异无统计学意义（P〉0.05）,骨、气导差距明显减小。在扩展高频段,鼓膜愈合前后所有频率气导阈值均高于对照组,差异有统计学意义（P〈0.05）,且穿孔愈合后有随着频率增高气导改善逐渐减少的趋势。结论外伤性鼓膜穿孔患者鼓膜愈合后常频段纯音气、骨导听阈恢复较好,但扩展高频区恢复较慢,甚至不可逆。     

碱性成纤维细胞生长因子对外伤性鼓膜穿孔的治疗观察

目的 观察碱性成纤维细胞生长因子（bFGF）对外伤性鼓膜穿孔的治疗效果。方法 随机将外伤性鼓膜穿孔分为两组：治疗组66例，用浸湿bFGF的压薄无菌棉片贴补，并每日两次用bFGF喷耳；对照组22例仅用贴补治疗。结果治疗4周后，治疗组鼓膜穿孔愈合率为98.3％，平均愈合时间为10．6天；对照组鼓膜穿孔愈合率为63．6％，平均愈合时间为22.2天。结论 bFGF浸湿棉片贴补加喷耳治疗外伤性鼓膜穿孔可促进穿孔愈合。缩短愈合时间。     

肝素明胶海绵治疗外伤性鼓膜穿孔的临床观察

目的 观察肝素明胶海绵贴补法治疗外伤性鼓膜穿孔的临床疗效.方法 外伤性鼓膜穿孔79例(83耳),分为试验组54例(58耳)和对照组25例(25耳),试验组给予肝素明胶海绵贴补治疗,对照组采用传统的干燥法保守治疗.随访4周,观察并记录鼓膜愈合情况及愈合时间.结果 4周内,试验组58耳共愈合56耳,愈合率为96.55％,对照组25耳共愈合14耳,愈合率为56.00％,二者差异有统计学意义(x2=18.79,P＜0.01).试验组平均愈合时间(从外伤至鼓膜愈合)为17.6d,对照组平均愈合时间为32.0 d,差异具有统计学意义(t=6.37,P＜0.01).试验组所有愈合鼓膜形态完整,和正常鼓膜相似,试验过程中未发现耳部皮肤过敏及感染等不良反应.结论 肝素明胶海绵能够促进外伤性鼓膜穿孔愈合,提高穿孔愈合率,缩短愈合时间.     

Healing time, long-term result and effects of stem cell treatment in acute tympanic membrane perforation

OBJECTIVE: The incidence of otitis media in children between the age of 2 and 6 years is well documented. Repeated attacks may cause acute and chronic perforations. The surgical treatment for repairing chronic perforation is quite uncomfortable for the patients of this age group because of the invasiveness of this treatment. The aim of this study was to determine the long-term influence of embryonic stem cells on acute perforations and the effect of gelatin as a vehicle for applied stem cells. The possibility of teratogenic effects of the stem cells was also observed. METHODS: Bilateral laser myringotomy was performed in 17 adult Sprague-Dawley rats, divided into two groups. Gelatin, a substance suitable as vehicle for bioactive material was used bilaterally around the perforation in group A, to serve as a scaffold for repairing tissue. The stem cells were used in the right tympanic membrane perforation leaving the left tympanic membrane as a control. The animals in group B received the same treatment except for the use of gelatin and in addition received an immuno-suppressive agent. After half a year of observation the mechanical stiffness of the tympanic membrane was measured by moiré interferometry for group B and the morphological study was performed by light microscopy for both groups A and B and electron microscopy for group A. RESULTS: Stem cell treated ears did not show any enhanced healing of the perforation although a marked thickening of the lamina propria was observed compared with control group. After half a year the strength and the stiffness of the tympanic membrane was almost the same for both treated and untreated ears. No evidence of teratoma was found after half a year. CONCLUSION: This study suggests that the stem cells stimulate the proliferation of connective tissue and fibers in the lamina propria, possibly mediated by secreted substances, although the stiffness properties do not seem to be altered. The use of gelatin does not seem to enhance the healing process of the tympanic membrane perforation.     

内镜下鼓膜成形术

目的评价内镜下修补干性鼓膜中、小穿孔的效果并与传统的烧灼法作对照。方法按完全随机法将鼓膜干性中央性中、小穿孔130耳分为两组,第一组100耳接受内镜下同种异体颞肌筋膜鼓膜成形术(内镜组),另30耳采用传统的40%三氯醋酸烧灼法进行修补(对照组)。比较两组间术后3个月鼓膜穿孔完全愈合的耳数以及术后6个月的语言频率纯音听阈的差异。结果术后3个月,内镜组鼓膜穿孔完全愈合率为91/100,较对照组的20/30高(P<0.01),术后6个月,两组鼓膜穿孔完全愈合者的骨-气导差在10dB以内的占90.1%。结论使用内镜修补鼓膜穿孔具有明显的优势,可代替手术显微镜且更容易通过狭窄或弯曲的外耳道,该手术是一种简单易行、安全有效的方法。     

Inhibition of epidermal growth factor receptor by erlotinib: wound healing of experimental tympanic membrane perforations.

HYPOTHESIS: Inhibition of epidermal growth factor receptor (EGFR) may arrest wound healing of experimental tympanic membrane perforation in rats. BACKGROUND: An animal model of chronic tympanic membrane perforation is needed for experiments on supporting wound healing of tympanic membrane perforations. The EGFR has been implicated in the regulation of wound healing. METHODS: Thirty animals were administered 80 or 40 mg/kg/d EGFR tyrosine kinase inhibitor, or vehicle only for 5 days. The right-sided tympanic membrane of each animal was perforated at Day 2. Rat ears were inspected repeatedly to analyze the status of perforation. Tympanic membranes were examined histologically. RESULTS: Unfortunately, five animals in the 80-mg/kg group and four in the 40-mg/kg group died before they reached their scheduled endpoint. Taking into account the small sample sizes, we observed a delayed closure of perforations in the 80-mg/kg group and differences in the histologic parameters between treated groups and control group. CONCLUSION: The inhibition of EGFR by systemic application of erlotinib seems not to be suitable to create a chronic tympanic membrane perforation in rat.     

Embryonic stem cells enhance the healing of tympanic membrane perforations

OBJECTIVE: Tympanic membrane perforations may cause hearing impairment and otorhea. It is a common indication for ear surgery. The aim of the study was to test whether stem cells may enhance the healing of fresh tympanic membrane perforations. METHODS: In a first assay, the status of the tympanic membrane at 5 days after myringotomy was tested in five Mongolian gerbils that were treated on one side with embryonic stem cells and on the other side with control substance. In a second assay, nine gerbils were treated in the same way, except that fluorescent-labeled embryonic stem cells were used. The integration of the stem cells into the surface layer of the healing tympanic membrane was assessed with fluorescence microscopy, as well as the differentiation of these cells. RESULTS: In the first assay, all perforations in the treated ears were closed, whereas only two of the untreated ears were closed. The strength of the healed perforation was greater in the stem cell treated tympanic membranes (mean rupture pressure 120 daPa in three treated ears compared to 60 daPa in the one control ear). Two stem cell-treated tympanic membranes remained intact throughout the whole sequence of pressures, whereas only one control tympanic membrane remained intact. In three tympanic membranes in the second assay, a group of fluorescence-doped cells was detected in the region of the perforation. CONCLUSION: These findings indicate that stem cells enhance the healing of tympanic membrane perforations, possibly by differentiation and integration into the tympanic membrane tissue.     

外伤性鼓膜穿孔的法医学鉴定分析

目的 总结外伤性鼓膜穿孔的法医学鉴定规律。方法 回顾性分析308例316耳外伤性鼓膜穿孔法医学鉴定资料。结果 确诊外伤性鼓膜穿孔237耳，穿孔愈合50耳，穿孔合并感染6耳，排除穿孔11耳，8例（耳）排除与所受外伤的关系，3例（耳）无法认定外伤性鼓膜穿孔，1例（耳）诊为慢性化脓性中耳炎。结论外伤性鼓膜穿孔诊断要点为：（1）有耳部或头部受伤史；（2）伴耳痛、耳聋、外耳道少量出血；（3）形态符合外伤性穿孔特点：穿孔多位于紧张部．呈裂隙状、三角形、不规则形等。穿孔边缘锐利、外翻，附有血痂；（4）声导抗检查不能引出鼓室图，或伤耳呈B型曲线但外耳道容积明显大于健耳；（5）排除中耳炎所致穿孔。声导抗和耳内镜检查可以客观真实的反映鼓膜穿孔的形态特征．能为外伤性鼓膜穿孔的法医学鉴定提供客观依据。     

重组表皮生长因子治疗外伤性鼓膜穿孔的临床观察

目的观察重组人表皮生长因子(reconstruct humar epidermic growth factor,rhEGF)明胶海绵贴补治疗外伤性鼓膜穿孔的疗效。方法rhEGF治疗外伤性鼓膜穿孔68例,按随机分组为治疗组37例,对照组31例。结果rhEGF治疗外伤性鼓膜穿孔,依穿孔部位及形态分为前下、下半、后半和后下4组,治疗组较对照组愈合时间(4周内),分别提前7．5,7．6,12．2,12.6天,未见明显不良反应。结论rhEGF贴补治疗可有效地促进外伤性鼓膜穿孔愈合,缩短愈合时间。     

Ventilation time of the middle ear in otitis media with effusion (OME) after CO2 laser myringotomy

OBJECTIVE: The aim of this study was to investigate the transtympanic ventilation time, the healing course of the tympanic membrane, the early and late complications, and the recurrence rate of otitis media with effusion (OME) within 6 months after CO2 laser myringotomy with the CO2 laser otoscope Otoscan. STUDY DESIGN: Prospective clinical study. MATERIALS AND METHODS: In this study, laser myringotomy was performed with the CO2 laser otoscope Otoscan in a patient population comprising 81 children (159 ears) with a history of otitis media with effusion (OME) associated with adenoidal and sometimes tonsillar hyperplasia. The procedure on the tympanic membrane was accordingly combined with an adenoidectomy, a CO2 laser tonsillotomy, or a tonsillectomy and therefore performed under insufflation anesthesia. In all ears, approximately 2 mm circular perforations were created in the lower anterior quadrants with a power of 12 to 15 W, a pulse duration of 180 msec, and a scanned area of 2.2 mm in diameter. RESULTS: None of the children showed postoperative impairment of cochleovestibular function such as sensorineural hearing loss or nystagmus. Otomicroscopic and videoendoscopic monitoring documented the closure time and healing pattern of tympanic membrane perforations. The mean closure time was found to be 16.35 days (minimum, 8 days; maximum, 34 days). As a rule, an onion-skin-like membrane of keratinized material was seen in the former myringotomy perforations at the time of closure. At the follow-up 6 months later, the condition of the tympanic membrane of 129 ears (81.1%) could be checked by otomicroscopy and videoendoscopy and the hearing ability by audiometry and tympanometry. The CO2 laser myringotomy sites appeared normal and irritation-free. Two of the tympanic membranes examined (1.6%) showed atrophic scar formation, and 1 (0.8%) had a perforation with a diameter of 0.3 mm. The perforation was seen closed in a control otoscopy 15 months postoperatively. OME recurred in 26.3% of the ears seen intraoperatively with mucous secretion (n = 38) and in 13.5% of the ears with serous secretion (n = 37; P <.05). CONCLUSION: The most important principle in treating OME is ventilation of the tympanic cavity. CO2 laser myringotomy achieves this through a self-healing perforation in which its diameter roughly determines the duration of transtympanic ventilation. Laser myringotomy competes with ventilation tube insertion in the treatment of OME. It may be a useful alternative in the surgical management of secretory otitis media.     

Tissue-engineered calcium alginate patches in the repair of chronic chinchilla tympanic membrane perforations

OBJECTIVE: Chronic tympanic membrane perforations are a common problem in the United States. A high number of these cases results from placement of pressure equalization tubes. These perforations may initially be treated with paper patch techniques and although safe and well tolerated, the procedure demonstrates poor efficacy. The ideal treatment for small perforations should be rapid, minimally invasive, and efficacious. Calcium alginate-based tissue engineered tympanic membrane patches represent an attractive option, but in vivo data are required. METHODS: A controlled prospective study of tympanic membrane perforation repair using a well-known chinchilla model of chronic tympanic membrane perforation was performed. Calcium alginate-based tympanic membrane patches were created using computer-aided design techniques. A previously described chinchilla model of chronic tympanic membrane perforations was used to create stable perforations ranging from 2 to 5 mm. Ears with chronic perforations were divided into three groups: control (no patch), paper patch, and calcium alginate plugs. At 10 weeks postimplantation, all animals were killed and inspected both grossly and histologically for healing. RESULTS: In the chinchilla model, the alginate grafts demonstrated significantly improved healing rates over both the untreated control group (spontaneous repair) and the paper patch group; nine of 13 healed in the alginate group versus two of nine healed in the paper patch group (P < .05) versus one of 11 healed in the control group (P < .05). CONCLUSION: Calcium alginate tympanic membrane perforation patches offer a significant advantage in the repair of chronic perforations over traditional techniques in the chinchilla perforation model and may offer attractive opportunities in the clinical setting.     

Fresh tympanic membrane perforations heal without significant loss of strength.

HYPOTHESIS: The mechanical and structural properties of the tympanic membrane change after a perforation has healed. BACKGROUND: In previous studies, efforts have been made to enhance the healing process of tympanic membrane perforations. The strength of the healed perforation has been tested with moiré interferometry in gerbils, but in no other species. METHODS: A laser myringotomy was made on 10 Sprague-Dawley rats and 10 CBA mice, and assessments were made after 2 or 4 weeks with moiré interferometry and light and electron microscopy. RESULTS: The mean peak displacement at pressure loads of +350 daPa and of -350 daPa did not differ significantly in the healed perforations as compared with the untouched tympanic membranes. Morphologic assays showed fivefold increased thickness at the site of the perforation due to invaded fibroblasts and extracellular matrix. CONCLUSION: Moiré interferometry was successfully performed in the rat ears, whereas in mouse ears the method was not easily applicable due to technical difficulties. The stress-strain curve of the rat tympanic membrane displays an S-shape. The strength of the spontaneously healed tympanic membrane after myringotomy was not significantly impaired. The site of the perforation became significantly thickened at 2 and 4 weeks post-myringotomy. This information is of clinical importance, because recently closed perforations will be challenged by pressure gradient in everyday life.     

A new method for closing tympanic membrane perforations using basic fibroblast growth factor

OBJECTIVE: To present a new method for closing tympanic membrane perforations using basic fibroblast growth factor (bFGF) combined with an atelocollagen/silicone bilayer membrane as a patch material. STUDY DESIGN: Closure of tympanic membrane perforations was attempted using bFGF, which is thought to facilitate the growth of fibroblasts and collagen fibers at the margin of the perforation. METHODS: Under an operating microscope, the margin of the perforation was trimmed, and a piece of an atelocollagen/silicone bilayer membrane infiltrated with 0.2 mL Trafermin (0.1% solution) (bFGF group) or saline (control group) was then placed in the perforation with the silicon layer facing outward. Nine patients were treated with bFGF, and five were treated with saline. Data obtained from patient records included patient age, perforation size, and duration of treatment, with a focus on hearing improvement and complete tympanic membrane closure. RESULTS: The mean perforation size before treatment was 16.5% in the bFGF group and 9.6% in the control group. Closure of the tympanic membrane perforation was achieved in all cases in the bFGF group, whereas it was achieved in only two of five cases in the control group. With bFGF treatment, the tympanic membrane perforations closed completely within 3.7 weeks, and hearing improved by 13.3 dB in the bFGF group. CONCLUSION: The study demonstrated that bFGF combined with an atelocollagen/silicone bilayer membrane is effective for the conservative treatment of tympanic membrane perforation.