重建上鼓室外侧壁的保留骨桥乳突切开鼓室成形术

目的探讨完桥式乳突切开鼓室成形术(intact-bridge tympanomastoidectomy,IBM)并用自体骨片重建上鼓室外侧壁的临床疗效。方法对48例(50耳)慢性化脓性中耳炎和中耳胆脂瘤患者采用IBM术式,清除病变后自体外耳道后壁骨片重建上鼓室外侧壁及听力重建,观察鼓膜愈合情况及听力提高水平,总结手术技术要点和术后疗效。结果术后随访3-21个月,干耳时间3-14周,平均6.7周;鼓膜穿孔愈合率92%(46/50耳),3耳因术后感染及1耳胆脂瘤上皮残留导致鼓膜穿孔不愈,经再次手术愈合。患耳的气导平均纯音听力(pure tone average,PTA)由术前53.7±6.9 d BHL提高到术后36.3±9.1d BHL,气骨导差(air-bone gap,ABG)由术前26.4±7.3 d BHL缩小到术后15.0±4.2d BHL,手术听力提高成功率(术后PTA-ABG≤20d BHL)为72%(36/50耳)。结论 IBM术式保留的"骨桥"对重建上鼓室外侧壁的骨片和鼓膜移植物起到支撑作用,结合上鼓室外侧壁重建保持了中上鼓室含气腔和正常外耳道后壁形态结构,减少术后鼓膜内陷袋形成,是中耳乳突手术的理想选择。     

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.     

乳突根治+开放式鼓室成形术治疗胆脂瘤中耳炎的体会

目的 探讨乳突根治+开放式鼓室成形术治疗胆脂瘤中耳炎的疗效.方法 对37例(37耳)胆脂瘤中耳炎患者行乳突根治+开放式鼓室成形术的临床资料进行分析.结果 随访1～3年,37例(37耳)移植筋膜成活,2例(2耳)鼓膜再穿孔,2例(耳)鼓膜疤痕内陷.术后6个月纯音气导平均听阈(0.5～4 kHz)为39.84±6.24dB...     

软壁式乳突根治鼓室成形术30例

2005年7月～2006年7月我科完成30例软壁式乳突根治加鼓室成形术,术中清除病灶,并用自体乳突皮质、颞肌筋膜及乳突肌骨膜瓣一期行外耳道后壁及中耳重建,疗效满意,现报告如下.     

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。     

伴有面隐窝开放的保留骨桥式乳突鼓室成形术

目的 分析胆脂瘤性中耳乳突炎的保留骨桥式乳突鼓室成形术(intact-bridge tympanomastoidectomy,IBM)术中面神经隐窝开放技术及其临床应用和远期治疗效果.方法 回顾性分析2000至2003年随访3年以上的63例(65耳)IBM术中开放面神经隐窝治疗的脂瘤性中耳炎病例的临床资料及随访结果 .在保留低位骨桥的解剖关系下,仍能安全开放面神经隐窝,有效清除后鼓室区域的隐匿病灶.结果 本组术后干耳时间4～13周,平均6.2周.62耳术后乳突腔上皮化良好,移植鼓膜愈合,干耳率95%(59/65).3耳耳漏及2耳胆脂瘤珠残留,经再次手术愈合.术后气骨导间距缩小值＞10 dB 60耳;平均语言频率气导听阈提高值为(18.5±7.3)dB.结论 基于术前颞骨高分辨CT,结合术中所见,在IBM手术中应用面神经隐窝开放技术,适用于后鼓室区域的探查与病灶清除,有助于减少术中残留和术后复发、提高远期效果.     

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。     

开放式乳突切除同期鼓室成形术

回顾2006年2月-2008年2月在我科行开放式乳突根治同期鼓室成形术的82例中耳胆脂瘤患者,疗效满意,报告如下。     

上鼓室重建及鼓室成形术在开放式乳突根治中的应用

目的 探讨重建上鼓室外侧壁在开放式乳突根治中的意义。方法 选择开放式乳突根治的病人，同时应用同种异体鼻中隔软骨或自体乳突皮质骨，重建上鼓室外侧壁，完成上鼓室成形术20例。结果 20例手术均获得干耳，术后3～6个月平均气导听力提高20dB以上4耳，l0～20dB 13耳。结论 应用同种异体鼻中隔软骨或自体乳突皮质骨，重建上鼓室外侧壁，能改善行开放式乳突根治病人的听力。     

完壁式乳突根治-鼓室成形术

胆脂瘤型中耳炎是耳科常见病,同时也是治疗上存在问题较多的疾病之一,完壁式乳突根治-鼓室成形术治疗胆脂瘤型中耳炎,既能彻底清除病灶,同时又能最大限度地保留或改善中耳及外耳道的生理结构和听觉功能,是治疗胆脂瘤型中耳炎的方法,本文介绍了该术式的手术方法、适应症的选择和胆脂瘤复发及处理等问题.     

Canal-wall-down tympanoplasty with mastoidectomy for advanced cholesteatoma

OBJECTIVE: The objective of this study was to review 8.5 years of the senior author's experience with canal-wall-down mastoid surgery for extensive cholesteatoma with high-grade atelectasis and severely destructed ossicles. DESIGN: A retrospective review was conducted. SETTING: The setting was a tertiary care medical centre. METHODS: Available records consulted included 104 canal-wall-down mastoidectomy for advanced-stage cholesteatomas between July 1984 and December 1992. MAIN OUTCOME MEASURES: Recurrence, hearing results, and dry ear rate were analyzed. RESULTS: The recurrence rate was 4 of 104 (3.8%), and 9.6% of subjects suffered from recurrent otorrhea. Thirty-seven of 104 (35.6%) achieved the closure of air-bone gap within 20 dB. The availability of stapes suprastructure influenced the postoperative hearing level significantly (p < .001). CONCLUSION: Even in treating advanced cholesteatoma, canal-wall-down mastoidectomy provides a low recurrence rate, establishes a high dry ear rate, and preserves adequate hearing when the stapes suprastructure is available for reconstruction.     

鼓索神经对听骨链重建术中纯音听阈测试结果的比较

目的：论证鼓索神经对听骨链重建的作用。方法：141例（154耳）患者分成3组：①鼓索神经弹压组（索弹组）35例（41耳）。鼓膜穿孔,鼓索尚存,臼柱即PORP或枪柱即TORP都在听骨外侧横行磨一细槽,嵌入鼓索神经,使鼓索神经能稳定弹压听骨,不使其移位。②残余鼓膜弹压组（膜弹组）67例（72耳）。用鼓膜弹压听骨。③无弹压组（无弹组）39例（41耳）。3组分别进行术前、术后气骨导差（ABG）自身配对S-t检验,并作术后ABG差值的两两对比和S-t检验。结果：显效、有效、无效率索弹组分别为：29．3％,51．2％,19．5％;膜弹组分别为：22．2％,50．0％,27．8％;无弹组分别为：19．5％,36．6％,43．9％;与无弹组比较,均P〈0．01。索弹组和膜弹组的术前、后ABG差值分别与无弹组比较,均P〈0．05。索弹组1耳术后有暂时味觉减退,1耳有迟发性轻度面瘫,均2周内自愈。结论：索弹听骨能使听骨稳定,获得良好的听力改善,不必二期手术;也不产生味觉及面神经功能障碍。     

外中耳畸形并发鼓索神经异常

目的：探讨鼓索神经异常在各类外,中耳中的发生率及其特征。方法：对６６７例外,中耳畸形患者行显微手术纠正的过程中发现或经术后证实鼓索神经变异４３３例,并对其进行分析。结果;鼓索神经变异在单纯中耳畸形组中发生率为１０．８８％（１６／１４７）,在外耳道狭窄畸形组中为２３．１５％（２２／９５）,在外、中耳畸形并胆脂且中为３．２３％（１／３１）,在外耳道骨性闭锁组中为１００％（３９４／３９４）。结果：鼓索神     

Schwannoma of the chorda tympani nerve

We report a case of schwannoma of the chorda tympani. This is a very rare benign tumour and only five other cases have been found in the literature. This is the first case to mimic a cholesteatoma presenting as a pearly tumour in the postero-superior segment of the drum with aural discharge and conductive deafness. Diagnosis is usually by biopsy and treatment is surgical with preservation of facial and auditory function. A summary of the other presentations of this tumour together with a review of the histopathology of the disease is presented.     

Neuroma of the chorda tympani nerve

This is a case report of an 18-year-old Negro female who presented with the chief complaint of a long standing hearing loss. Physical examination revealed a large mass in the right external auditory canal which occupied 80 percent of the cross section area. There was only a tiny rim of the inferior tympanic membrane visable. The patient had a 60 db conductive hearing loss. Mastoid films were normal. At surgery the mass was found to extend into the attic and to almost completely fill the middle ear. When the tumor was removed from the attic, under the malleus and the hypotympanic area, the only attachment was the chorda tympani nerve. The pathology report was neuroma. Photographs were taken and illustrations are presented to confirm these findings. Neuroma has been reported as originating from every branch of the facial nerve with the exception of the chorda tympani nerve. This site of origin has been strikingly absent, especially since the chorda tympani is a component of the facial nerve. Our case is presented to document such an occurrence.     

Red chorda tympani nerve and Bell's palsy

This is the first report of a red chorda tympani nerve observed in association with Bell's palsy. A prospective study was designed to determine the frequency and significance of this sign in association with Bell's palsy. Twenty-eight patients were evaluated within two days of onset of paralysis. The red chorda tympani sign was correlated with alterations in chorda tympani function in terms of taste and submandibular salivary flow as well as response of the extracranial facial nerve to the maximal stimulation test. The chorda tympani was red in 10 of 20 patients (50 percent) where the nerve could be seen through the tympanic membrane. This finding is discussed in terms of a viral-inflammatory involvement of the chorda tympani as part of the pathogenesis of Bell's palsy. In addition, the red chorda tympani sign was clinically significant. It indicated a more severe involvement of the chorda tympani than in those patients where the nerve was normal. The patients with the finding had a greater incidence of loss of taste by history and testing. In addition, 4 of the 10 patients with a red chorda tympani on the side of the facial paralysis had a salivary flow of less than 25 percent as compared to only 1 of 10 patients with a normal chorda tympani on the ipsilateral side. The study suggested a worse prognosis for patients with a red chorda tympani, although the difference was not statistically significant. The most important clinical significance of the red chorda tympani was its exclusive association with Bell's palsy and, therefore, may be an important diagnostic sign.     

Incidence of regeneration of the chorda tympani nerve after middle ear surgery

We retrospectively reviewed 52 patients who underwent middle ear surgery during which the chorda tympani nerves were severed and who then underwent secondary surgery 1 to 5 years later. In 22 patients (42.3%), regenerated chorda tympani nerves (entire length of the tympanic segment) were detected in the submucosal layer of the reconstructed eardrum during the secondary surgery. Before the secondary surgery, 16 patients (30.8%) showed threshold recovery on electrogustometry. When 5 regenerated nerves were observed by transmission electron microscopy, myelinated nerve fibers were detected in a small fascicle or connective tissue, but the number of myelinated axons was significantly decreased (7.4% to 84.6%; p = .01) compared with that in normal subjects (1,911 +/- 324; n = 4). There was a significant difference in the incidence of regeneration between the group with end-to-end anastomosis (5/5 or 100%) and that with nerve gap defects (17/47 or 36.2%; p <.05); this finding suggests that repair of the sectioned nerve produces a better incidence of regeneration than leaving the nerve unrepaired.     

A study of chorda tympani nerve injury and related symptoms following middle-ear surgery

This is a prospective study that looks into the prevalence of chorda tympani nerve (CTN) injury and related symptoms following varying degrees of trauma to the nerve during three common types of middle-ear operation: myringoplasty, tympanotomy and mastoidectomy. The number of patients with CTN-related symptoms varied widely between the three groups. Increased occurrence of the nerve related symptoms and a prolonged recovery time were observed in the tympanotomy group. Stretching of the nerve produced more symptomatic cases than cutting it in the myringoplasty and mastoidectomy groups. Recovery was complete in 92 percent of the symptomatic patients by 12 months. It is important to inform patients about the possibility of CTN injury during middle-ear operations, and it should also be emphasized that symptoms related to CTN injury can occur irrespective of the type of damage to the nerve.     

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.     

Taste function after section of chorda tympani nerve in middle ear surgery

ObjectiveTo investigate prospectively the clinical manifestations and the functional recovery of taste after section of chorda tympani nerve (CTN) during middle ear surgery, the subjective and objective study on the patients was performed.MethodsThirty-five patients underwent surgery with unilateral (n = 32) or bilateral (n = 3) section of CTN between January 2000 and April 2002. The patients were asked about taste symptoms before surgery and 2 weeks and 2 years after surgery. The CTN function was also measured with electrogustometry (EGM) at the same time points.ResultsIn unilateral section of CTN, 19/32 (59.4%) complained of taste disorder and 11/32 (34.4%) tongue numbness. Most of these taste symptoms disappeared within 2 years although the EGM threshold did not recover. 16/17 patients (94.1%) who used to cook everyday had little difficulty in flavoring dishes. In bilateral section of CTN, the patients had no problem of taste at 2 years after surgery, either.ConclusionThese findings help explain the potential complications to the patients before surgery, although the number of cases was small in this series.