鼓膜紧张部中央性大穿孔患者中耳乳突病变的特点及处理

目的:探讨慢性化脓性中耳炎(单纯型,静止期)伴鼓膜紧张部中央性大穿孔患者的病变特点及处理方法。方法:慢性化脓性中耳炎(单纯型,静止期)伴鼓膜紧张部中央性大穿孔患者147例,其中101例不伴乳突病变者行鼓室成形术;46例伴乳突病变者,在进行鼓室成形术的同时进行乳突开放术。结果:147例中有142例(96.6%)一期愈合。术后3个月纯音听力骨气导差平均为(16.6±10.9)dBHL。结论:慢性化脓性中耳炎(单纯型,静止期)伴鼓膜紧张部大穿孔的患者,术前颞骨高分辨CT检查及术中详细探查是必须的。确保术后咽鼓管、上鼓室、鼓窦,特别是后两者的引流通畅是提高疗效的关键。应用软骨软骨膜复合物行鼓膜重建或上鼓室、后鼓室及鼓膜的联合重建,对鼓膜紧张部中央性大穿孔的患者不失为一种切实可行的治疗方法。

Tympanoplasty and mastoidectomy in patients with large perforation of tympanic membrane in pars tensa

OBJECTIVE: To present the experiences of tympanoplasty in patients with large perforation of tympanic membrane in pars tensa. METHOD: Of 147 patients who underwent surgery for chronic otitis media with large perforation of tympanic membrane in pars tensa,101 patients without mastoid problem underwent tympanoplasty, 46 patients who had evidence of middle ear, antral/epitympanic, or mastoid disease underwent tympanoplasty with mastoidectomy. RESULT: The tympanic membrane graft take rate for the entire group of 147 patients was 96.6% (142 grafts succeed). The average postoperative pure tone air-bone gap was (16.6 +/- 10.9) dBHL after 3 months of the operation. CONCLUSION: To patients with chronic supperative otitis media and large perforation of tympanic membrane, the CT scan before operation and detailed exploration of tympanum are necessary. The drainage of Eustachian tube, attic and antrum must be enough. The cartilage-perichondrium composite is an ideal material for reconstruction of the drum, the attic and the posterior tympanum.