保留听骨链的低位完桥鼓室成形术

目的 探讨保留听骨链的完桥式鼓室成形术对上鼓室有阻塞性病变的慢性化脓性中耳炎的效果.方法 对23例上鼓室肉芽包裹听骨链阻塞鼓窦入口、影响上鼓室引流的慢性化脓性中耳炎患者采用低位完桥鼓室成形术(鼓窦入口及上鼓室外侧壁保留更加狭窄的低位"骨桥"样结构),彻底清除病变组织,松解活动受限的听骨链,疏通中、上鼓室的引流,术后随访0.5~3年,观察疗效.结果 23例患者术前平均纯音听阈(0.5~2 kHz)为43.91±9.90 dB HL,气骨导差为24.04±5.10 dB,术后随访期内平均纯音听阈稳定,为33.17±7.63 dB HL,气骨导差为14.70±4.52 dB;所有患者3月内获得干耳;无复发或再次鼓膜穿孔病例;1例术后6月后出现鼓室积液(分泌性中耳炎),行鼓膜置管(T型管),6个月后拔管,随访1年,未再复发.结论 对上鼓室有阻塞性病变的慢性化脓性中耳炎患者进行保留听骨链的低位完桥鼓室成形术,复发率低,提高听力效果好.

Lower Intact-Bridge Tympanomastoidectomy with Preservation of Ossicular Chain

Objective To reduce the recurrence rate and improving the hearing recovery effect in chronic otitis media patients with obstructive lesions in the attic, through the low bone intact-bridge tympanomastoidectomy.Methods A total of 23 patients with little severe or severe localized attic lesions granulation wrapped in ossicular chain blocking the entrance of tympanic antrum or affecting the attic drainage were included in this study.We have modified the intact-bridge tympanomastoidectomy to low bone intact-bridge tympanomastoidectomy (At the tympanic antrum entrance and lateral attic wall, we retained a more narrow low "bone bridge"structure), completely cleared the localized lesions, released the activities limited ossicular chain and unobstructed the attic and middle tympanum drainage channel.And patients were followed up for 0.5~3 years.Results Before operations, the average pure tone auditory hearing threshold of all 23 patients was 43.91±9.90 dB HL,the preoperative air-bone gap was 24.04±5.10 dB.While the postoperative stable pure tone hearing test results were 33.17±7.63 dB HL and 14.70±4.52 dB, respectively.All patients had postoperative dry ear within 3 months.There was no recurrence of tympanic membrane perforation during follow-up.One patient had tympanic effusion(secretory otitis media) had accepted grommet insertion, 6 months after T-tube insertion, the tube was removed, and was followed up to 1 year.Conclusion The low bone intact-bridge tympanomastoidectomy by preservation of low bone bridge used in patients with chronic otitis media and obstructive lesions in the attic middle tympanum could reduce the recurrence rate and improve the recovery of hearing.