骨性外耳道后壁重建鼓室成形术治疗胆脂瘤型中耳炎的疗效观察

目的：探讨处理乳突根治术后遗留的外耳道后壁缺损及开放的乳突腔的方法。方法：应用骨性外耳道后壁重建鼓室成形术治疗胆脂瘤型中耳炎58例（58耳），清除病变的同时以颞骨皮质骨行骨性外耳道后壁重建并Ⅰ期行鼓室成形术。结果：随访1～3年，仅有1例胆脂瘤复发（复发率1．72％）。外耳道接近正常形态，保留含气乳突腔。纯音听阈提高30dBHL以上者（极效）5耳，提高20～29dBHL者（显效）11耳，提高10～19dBHL者（有效）30耳，总有效率为79．31％（46／58），〈10dBHL者（基本无效）8耳，无听力提高者（无效）4耳。术后平均气导听阈明显减少。结论：乳突根治术后以颞骨皮质骨行骨性外耳道后壁重建并Ⅰ期行鼓室成形术，有助于修复乳突根治术后遗留的外耳道后壁缺损及开放的乳突腔，改善听力，降低胆脂瘤复发率，是一种较为实用的手术方法。

Evaluation of tympanoplasty with reconstruction of the external canal after mastoidectomy for cholesteatoma

Objective:To investigate the method to repair the deletion of external canal and opened mastoid space after mastoidectomy.Method:Onestage tympanoplasty with reconstruction of the external canal with temporal cortex was completed in 58 cases (58 ears) with cholesteatoma.Result:During the follow-up ranging from one to three years, there was only one relapse. The configuration of external canal was almost normal and pneumatic mastoid space was maintained. Hearing was improved over 30dB in five ears, 20 to 29 dB in 11 ears, 10 to 19 dB in 30 ears, less 10 dB in eight ears and hearing wasn't improved in four ears.Conclusion:One stage tympanoplasty with reconstruction of the external canal after mastoidectomy for cholesteatoma is a practical way to improve hearing and decrease recurrence.