不同状态的慢性化脓性中耳炎施行鼓膜成形术的回顾性分析

李慧林; 张志飞; 王武庆

doi:10.13201/j.issn.1001-1781.2017.19.003

不同状态的慢性化脓性中耳炎施行鼓膜成形术的回顾性分析

- 1 新疆喀什地区第二人民医院耳鼻咽喉头颈外科(新疆喀什, 844000);
- 2 复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科

详细信息

通讯作者: 王武庆, E-mail:wwuqing@eent.shmu.edu.cn

中图分类号: R764.21

收稿日期: 2017-06-05

Different states of otitis media were retrospectively analyzed of myringoplasty

- 1 Department of Otolaryngology Head and Neck Surgery, the Second People's Hospital of Kashi, Kashi, 844000, China;
- 2 Department of Otolaryngology Head and Neck Surgery, EENT Hospital of Fudan University

More Information

Corresponding author: WANG Wuqing, E-mail: wwuqing@eent.shmu.edu.cn

Received Date: 05 June 2017

摘要

摘要: 目的: 分析慢性化脓性中耳炎行鼓膜成形术后的鼓膜穿孔率及听力改善率,观察术前中耳病变、咽鼓管功能及感染等不同状态对术后疗效的影响。方法: 回顾性分析203例(203耳)行鼓膜成形术患者的临床资料:根据术中探查鼓室内有无脓性分泌物积聚,分为感染活动期组和感染静止期组;根据术前声导抗结果,分为咽鼓管功能不良组和咽鼓管功能良好组;根据术前颞骨HRCT提示中耳(乳突、鼓窦、鼓室)有无软组织密度影,分为中耳无明显病变组和中耳有局限病变组。术后3~6个月复查耳内镜和纯音测听,采用SPSS 19.0统计软件比较不同组别术后鼓膜穿孔率和听力改善率的差异。结果: 单因素分析:①感染静止期组术后鼓膜穿孔率为11.93%(13/109),高于感染活动期组[8.51%(8/94)];感染静止期组术后听力改善率为75.23%(82/109),低于感染活动期组[79.79%(75/94)],差异均无统计学意义(P>0.05)。②咽鼓管功能不良组术后鼓膜穿孔率为14.06%(9/64),高于咽鼓管功能良好组[4.04%(4/99)],差异有统计学意义(P<0.05);咽鼓管功能不良组术后听力改善率为76.56%(49/64),低于咽鼓管功能良好组[81.82%(81/99)],差异无统计学意义(P>0.05)。③中耳无明显病变组术后鼓膜穿孔率为9.09%(10/110),低于中耳有局限病变组[11.83%(11/93)];中耳无明显病变组的术后听力改善率为78.18%(86/110),高于中耳有局限病变组[76.34%(71/93)],差异均无统计学意义(P>0.05)。多因素分析:①术前咽鼓管功能与术后鼓膜的穿孔率有明显的相关性(P<0.05),术前感染状态及颞骨HRCT影像提示的中耳病变情况与术后鼓膜的穿孔率均不存在明显的相关性(P>0.05)。②术前感染状态、咽鼓管功能及颞骨HRCT影像提示的中耳病变情况与术后的听力改善率均不存在明显的相关性(P>0.05)。结论: 术前咽鼓管功能不良及中耳局限性病变多见于感染活动期;鼓室黏膜表面脓性分泌物积聚及中耳局限性病变不影响术后的鼓膜愈合率及听力改善率;咽鼓管功能是影响术后鼓膜愈合率的一个重要因素,咽鼓管功能障碍者其术后鼓膜穿孔的可能性更大,但不影响术后的听力改善率。
- 中耳炎 /
- 鼓膜成形术 /
- 咽鼓管 /
- 鼓膜穿孔 /
- 预后因素
Abstract: Objective: Through analysis of the tympanic membrane perforation rate and hearing improvement rate with chronic suppurative otitis media (CSOM) by myringoplasty, to observe the effect of different preoperative conditions such as middle ear lesion, eustachian tube (ET) function and infection status on the postoperative curative effect.Method: Retrospective analysis of EENT Hospital of Fudan University from January 2012 to November 2016 during the 203 cases (203 ears) with clinical data of myringoplasty:according to intraoperative exploration of the presence of purulent secretions in the tympanic cavity, divided into infection active group and infection quiescence group; according to the preoperative results of the function of ET with acoustic impedance test divided into dysfunction or good group; according to the preoperative temporal bone HRCT suggested that the middle ear (mastoid cells, tympanic antrum and tympanic cavity) with or without soft tissue density, divided into the group with no focal lesion and the group with focal lesion. Review endoscopy and pure tone audiometry after 3 to 6 months. Using SPSS 19.0 statistical software to compare the differences among them of tympanic membrane perforation rate and hearing improvement rate.Result: Single factor analysis:①The infection quiescence group of tympanic membrane perforation rate was 11.93%(13/109), higher than the infection active group[8.51%(8/94)]; the infection quiescence group of hearing improvement rate was 75.23%(82/109), below the infection active group[79.79%(75/94)], no statistically significant differences of them (P>0.05).②The group with dysfunction of ET of tympanic membrane perforation rate was 14.06%(9/64), significantly higher than the group[4.04%(4/99)] with good function ET, with statistical difference of them (P<0.05); the group with dysfunction of ET of hearing improvement rate was 76.56% (49/64), lower than the group[81.82%(81/99)] with good function of ET, no significant difference of them (P>0.05).③The group with no obvious lesion of tympanic membrane perforation rate was 9.09% (10/110), lower than the group[11.83%(11/93)]with focal lesion; the group with no obvious lesion of hearing improvement rate was 78.18% (86/110), higher than the group with focal lesion[76.34%(71/93)], no significant difference of them (P>0.05).Multivariate analysis:①There was a significant correlation of postop-erative tympanic membrane perforation rate with preoperative ET functi-on (P<0.05).There was no significant correlation of the postoperative tympanic membrane perforation rate with the infection status and the temporal bone HRCT images in the middle ear lesions (P>0.05).②There was no significant correlation of the postoperative hearing improvement rate with the infection status, the ET function and the temporal bone HRCT images in the middle ear lesions (P>0.05).Conclusion: Dysfunction of ET and localized lesions of the ear were more common in infection active;the accumulation of purulent exudate on the surface of the tympanic mucosa and localized lesions of the middle ear did not affect the healing rate of the tympanic membrane and the hearing improvement rate; ET function is one of the most important factors that affect the healing rate of tympanic membrane after operation, the patients with ET dysfunction are more likely to affect tympanic membrane perforation, but does not affect the hearing improvement rate.
- otitis media /
- myringoplasty /
- eustachian tube /
- tympanic membrane perforation /
- prognostic factors

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