内外植法与内植法鼓膜成形术的近期对比分析

目的:探讨内外植法修补鼓膜的成功率和对听力的影响.方法:回顾性分析2002年以来行内植法鼓膜成形术且术后随访6个月以上的74例(77耳)患者,A组44例(45耳)采用传统的内植法,B组30例(32耳)将移植膜放置在残余鼓膜与锤骨柄之间(内外植法),比较2组患者术后3个月时的听力.结果:A组鼓膜1次修补成功40耳(89.0%),语言区平均听阈改善≥10 dB者23耳,手术成功率57.5%.B组鼓膜修补1次愈合28耳(87.5%),语言区平均听阈改善≥10 dB者23耳,手术成功率71.9%.并发症:A组再穿孔2耳(5.9%),鼓膜内陷8耳(17.8%);B组再穿孔2耳(6.25%),钝角愈合3耳(9.38%),鼓膜内陷2耳(6.25%).结论:将移植膜放置在残余鼓膜与锤骨柄之间可避免术后鼓膜和锤骨柄脱离,减少移植膜与鼓岬发生粘连.对鼓膜较大穿孔患者听力的改善明显优于移植膜放置在锤骨柄内侧者.

Comparative evaluation of over-under myringoplasty and underlay myringoplasty for repairing tympanic membrane perforation

Objective:To evaluate the effect of over-under myringoplasty technique on repairing tympanic membrane perforation regarding with the rate of perforation closure, the frequency of postoperative complications occurrence and the level of hearing improvement.Method:In this retrospective study, a total of 74 patients (77 ears) underwent myringoplasty and had been followed up for over 6 months, which was performed by means of the underlay technique in 44 patients (45 ears) and over-under technique in 30 patients (32 ears) from Jan 2002 to Jan 2007. In the underlay group, the grafted membrane was placed medial to the remaining drum and the manubrium of the malleus. In the over-under group, the grafted membrane was placed under the remaining drum and over the malleus. Comparatively evaluate the effect of the underlay technique and that of the over-underlay technique on repairing tympanic membrane perforation.Result:The rate of perforation closure and hearing improvement in the underlay group of 45 ears was 89.0% and 57.5% respectively, while that in the over-under group of 32 ears were 87.5% and 71.9% respectively. The air-bone gap decreased by 4.9 dB in the underlay group, while it decreased by 9.7 dB in over-under group. After more than 6 months of following-up, the frequency of postoperative atelectasis of the underlay group and the over-under group was 17.8% and 6.25% respectively. Meanwhile, the frequency of postoperative reperforation of these two groups was 5.9% and 6.25% respectively. Blunting of the anterior angle of the tympanic membrane occurred in 3 ears in the over-under group. Lateralization of the graft was not observed in either group.Conclusion:Over-under technique could reduce the occurrence of the adhesions between the grafted membrane and promontorium tympani by placing the grafted membrane between the remaining drum and the malleus. Furthermore, the level of hearing improvement in over-under group was higher than that in underlay group. Over-under myringoplasty is a more effective technique as comparison to underlay myringoplasty for repairing middle to large tympanic membrane perforations.