自体皮质骨外耳道上鼓室重建及骨粉乳突填塞在鼓室成形术中的应用

目的　探讨自体皮质骨外耳道上鼓室重建及骨粉乳突填塞在鼓室成形术中的应用价值。方法　选取我院2014年1月～2016年1月收治中耳胆脂瘤患者共30例，随机分为对照组和观察组，对照组行经典开放式乳突根治鼓室成形术，观察组行开放式乳突根治鼓室成形术以及自体皮质骨外耳道上鼓室重建和骨粉乳突填塞。比较两组患者治疗效果。结果　两组治疗前语频区平均气骨导差比较和气导听阈比较，差异无统计学意义。治疗后两组语频区平均气骨导差对比，差异有统计学意义（t =13.084，P <0.05）；两组气导听阈对比，差异有统计学意义（t =12.682，P <0.05）；均为观察组显著低于对照组。两组随访期间均无胆脂瘤复发；观察组干耳时间较对照组明显缩短，且干耳率显著高于对 照组，差异均具有统计学意义（t =2.758、4.865，P <0.05）。结论　开放式乳突根治鼓室成形术以及自体皮质骨外耳道上鼓室重建和骨粉乳突填塞方法治疗中耳胆脂瘤，可以有效提高患者听力，降低胆脂瘤复发率和增加干耳率，临床上值得进一步推广应用。

Application of the cortical bone packing in external auditory bony canal and attic reconstruction in tympanoplasty with mastoid obliteration

OBJECTIVE To explore the application value of the cortical bone packing in external auditory bony canal and attic reconstruction in tympanoplasty.METHODS A total of 30 patients admitted during the period of middle ear cholesteatoma patients in our hospital from March 2014 to March 2016,were randomly divided to observation group and control group,the radical mastoidectomy with canal wall down was adopted in the control group,the radical mastoidectomy with canal wall down combined with bone autograft in the external auditory meatus and bony powder mastoid obliteration in observation group,the postoperative out-come between two groups were compared.RESULTS There was no significant difference between the speech frequency average air bone conduction and air conduction threshold before the treatment in two groups.There was significant difference between the speech frequency average air bone conduction and air conduction threshold after the treatment(P＜0.05),the air conduction threshold significantly reduced,the patients in the observation group were significantly lower than the control group,there was no recurrence of cholesteatoma in two groups of patients before and after the treatment during follow-up period;the dry ear time in observation group was significantly lower than that of the control group,and dry ear the incidence was significantly higher than that of the control group,the difference is statistically significant(t=2.758,4.865,P＜0.05).CONCLUSION Radical mastoidectomy with canal wall down combined with the cortical bone packing in external auditory bony canal and attic reconstruction,can effectively presesre the patient hearing,it should be recommended.