Clinical analysis of tympanoplasty combined with ventilation tube insertion in otitis media
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摘要: 目的：探讨鼓室成形同期行鼓膜置管术的可行性及其临床疗效。方法：回顾性分析35例因咽鼓管不通或鼓室粘连行鼓室成形同期行鼓膜置管术患者的资料。术前常规行听力测试和颞骨CT检查。术中彻底清除病变的同时并尽可能地保护鼓室内壁黏膜的完整性，重建听骨链及同期行鼓膜造孔并放置硅胶T型通气管。术后3个月，全部患耳行纯音听阈测试。术后随访12~44个月。结果：术后平均语频听力（0.5、1.0、2.0 kHz）气导PTA为（31.71±12.25）dBHL，28例（80.0%）术后听力提高至40 dBHL以内的实用水平，5例（14.3%）术后听力提高了10~20 dBHL，2例（5.7%）术后听力无变化。术后0.5、1.0、2.0 kHz各频率气骨导差（ABG）缩小至20 dBHL以内的病例数分别为25、32、34例。鼓膜置管自行脱出15例，人为取出12例，在位通畅8例。27例置管自行脱落或人为取出的鼓膜遗留穿孔，其中22例（81.5%）自行愈合，5例（18.5%）仍遗留直径<2 mm的小穿孔。全部患耳术后均干耳，无一例复发，33例（94.3%）12周内干耳，仅2例（5.7%）干耳时间超过6个月。结论：鼓室成形同期行鼓膜置管术对于中耳黏膜功能障碍及咽鼓管黏膜功能障碍或不通的中耳炎疗效明显。同期置入的鼓膜通气管并不会延长干耳时间和引起术后复发。鼓室成形同期行鼓膜置管术操作可行、技术可靠、疗效明确。Abstract: Objective: The aim of this study is to explore the feasibility and clinical effect of tympanoplasty combined with ventilation tube insertion in otitis media.Method: Retrospective analysis of 35 patients with eustachian tube obstruction or tympanic adhesions for tympanoplasty combined with ventil ation tube insertion in otitis media in EENT Hospital of Fudan University from April 2008 to December 2010. Preoperative routine hearing tests and temporal bone CT examination. Completely remove of lesions at the same time and as much as possible to protect the integrity of the tympanic wall mucosa during operation. Reconstruction of the ossicular chain and simultaneous tympanic membrane hole and placed silicone T-type ventilation tube. All patients were tested for pure tone auditory threshold at 3 months after operation. The patients were followed up for 12 to 44 months.Result: The average hearing level of PTA(0.5,1.0,2.0 kHz) was(31.71±12.25)dBHL. 28 cases(80.0%) had improved to 40 dBHL after operation, 5 cases(14.3%) had hearing enhancement of 10-20 dBHL, and 2 patients(5.7%) had no change in hearing. The number of cases with air bone gap(ABG)(0.5,1.0,2.0 kHz) reduced to less than 20 dBHL was 25, 32 and 34 after operation. Ventilation tube self-prolapse in15 cases, 12 cases of artificial removal and 8 cases of inpatient. Twenty-seven cases were left perforation of tympanic membrane, of which 22 cases(81.5%) were spontaneously healed and 5 cases(18.5%) were left with small perforations less than 2 mm in diameter. All of them had dry ear after operation, none of them had recurrence after operation, 33 cases(94.3%) had dry ear within 12 weeks, and only 2 cases(5.7%) had dry ear for more than 6 months.Conclusion: Tympanoplasty combined with ventilation tube insertion for the middle ear mucosal dysfunction and eustachian tube mucosal dysfunction of otitis media treatment effect is obvious. It does not extend the dry ear time and cause postoperative recurrence. This operation is feasible, reliable and effective.
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Key words:
- tympanoplasty /
- ventilation tube insertion /
- eustachian tube /
- otitis media
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