多种技术治疗慢性中耳炎

目的探讨慢性中耳炎手术方法。方法2005年7月至2007年7月为45例46耳慢性中耳炎，胆脂瘤性中耳炎及中耳炎后遗症患者经耳内切口，在清除病灶的同时采用自体外耳道一乳突骨膜，骨质修补鼓膜，重建上鼓室盾板，外耳道后壁，听骨链，术后随访达12—36个月，以最后一次随访听力记录为统计数据，统计分析用配对t检验。结果46耳术后AC，BC和ABG术前术后差值（dBHL）为22．74±12．45，6．16±5．07和17．87±7．14，经配对t检验，P均〈0．01，差异有显著统计学意义。43耳（93．5％）获得形态正常外耳道，鼓膜及含气的中耳腔，1耳外耳道存在过敏湿疹溢液，1耳大胆脂瘤伴中耳积液，鼓膜置管，持续有分泌物，给予再次手术后听力改善满意。结论慢性中耳炎术中行耳内切口采用自体外耳道一乳突骨膜骨质修补鼓膜，重建上鼓室盾板，外耳道后壁，听骨链，能达到彻底清除病灶，提高听力的目的，自体移植材料成活率高，痛苦少，经济且无碍美容。

Surgical treatments for chronic otitis media

Objective To review surgical approaches used in treating chronic otitis media. Methods Forty five cases (46 ears) of chronic otitis media treated between July 2005 and July 2007 were reviewed. The intra-aural approach was used in these cases. Following complete debridement, the tympanic membrane was repaired using autograft periosteum and sometimes bony cortex. When indicated, the attic scutum, posterior wall of external auditory meatus and ossicular chain were reconstructed using autograft materials. The patients were followed for 12 to 36 months post-operatively. Preoperative and the last follow-up audiometric parameters were compared using paired t-test. Results The average air conduction threshold, bone conduction threshold and air-bone gap over 0.5,1 and 2 kHz improved by 22.74 ± 12.45, 6.16 ± 5.07 and 17.87 ± 7.14 dB, respectively (P< 0.01). In 43 ears (93.5%), normal-looking external auditory canal and tympanic membrane and pneumatized middle ear cavity were restored.Allergic eczema in the external auditory meatus with exudates occurred in 1 ear. In another ear with large cholesteatoma, a revision procedure was needed for disease recurrence that failed to improve after tube placement, with satisfactory hearing outcome. Conclusion Debridement through an intra-aural approach, followed by primary middle ear reconstruction with autograft materials is an effective surgical treatment for chronic suppurative otitis media. Compared to other materials, autograft materials are more likely to survive, cost less and cosmetically more acceptable.