Observation of the short-term effect of tympanoplasty(type Ⅰ) in dry and wet ears with chronic otitis media
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摘要: 目的 探究慢性中耳炎干湿耳状态下行经耳内镜鼓室成形术(Ⅰ型)的近期疗效差异。方法 前瞻性纳入2018年7月—2020年7月于陕西省人民医院耳鼻咽喉头颈外科收治的慢性化脓性中耳炎静止期患者，术前由2名耳内镜医师独立判断鼓膜及鼓室黏膜情况，将110例患者分为干耳组(78例)和湿耳组(32例)。记录鼓室成形术后1、3、6个月时的鼓膜愈合率和听力改善程度。结果 干耳组在术后6个月愈合率为97.4%(76/78)，湿耳组在术后6个月愈合率为96.9%(31/32)；两组鼓膜愈合率差异无统计学意义(P>0.05)。两组患者听力均较前改善，干耳组气导听力术后较术前提高(10.57±8.73) dB，气骨导差术后较术前下降(6.44±4.98) dB；湿耳组气导听力术后较术前提高(8.91±11.79) dB，气骨导差术后较术前下降(6.89±6.99) dB。两组在听力改善程度上差异无统计学意义(P>0.05)。结论 对于不伴有听骨链病变的静止期慢性中耳炎，术前湿耳状态不作为鼓室成形术(Ⅰ型)的手术禁忌，其术后鼓膜愈合率以及听力改善程度与干耳手术一致，并且可以降低患者术前等待时间，减少抗生素的使用。Abstract: Objective To explore the difference of short-term effect of transear endoscopic tympanoplasty (type Ⅰ) in the dry and wet ear of chronic otitis media.Methods Patients with chronic suppurative otitis media were prospectively recruited in the Department of Otorhinolaryngology Head and Neck Surgery, Shaanxi Provincial People′s Hospital from July 2018 to July 2020. Two otoscopicians independently judged the condition of tympanic membrane and tympanic mucosa before operation. One hundred and ten patients were divided into dry ear group (n = 78) and wet ear group(n = 32). The healing rate of tympanic membrane and the degree of hearing improvement were recorded at postoperative 1 month, 3 months and 6 months.Results Six months after operation, the healing rate of dry ear group was 97.4% (76/78), and that of wet ear group was 96.9%(31/32) 6 months after operation, there was no significant difference in tympanic membrane healing rate between the two groups (P>0.05). The hearing of the patients in both groups was improved, and the air conduction hearing in the dry ear group increased by (10.57±8.73) dB, and decreased by (6.44±4.98) dB after operation. In the wet ear group, the air conduction hearing increased by (8.91±11.79) dB, and decreased by (6.89±6.99) dB after operation. There was no significant difference in the degree of hearing improvement between the two groups(P>0.05).Conclusion For quiescent chronic otitis media without ossicular chain lesions, the preoperative wet ear state is not a taboo in tympanoplasty (typeⅠ), and the postoperative tympanic membrane healing rate and hearing improvement are the same as those in dry ear surgery, and can reduce the preoperative waiting time of patients, reduce the use of antibiotics.
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Key words:
- otitis media /
- dry ear /
- wet ear /
- tympanoplasty /
- endoscope
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表 1 临床一般资料
项目 干耳组 湿耳组 年龄/岁 42.64(21~60) 42.13(19~60) 性别 男 40 16 女 38 16 侧别 左 49 20 右 29 12 穿孔大小/mm 大(>6) 9 6 中(3~6) 38 11 小(<3) 31 15 乳突气化 良好 58 22 不良 20 10 病程/月 46.43±9.67 53.81±10.32 术前气导/dB 41.63±16.08 47.07±21.50 气骨导差/dB 16.11±5.77 17.94±5.92 
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表 2 术后6个月时听力恢复情况
变量 干耳 湿耳 t P 术前气导听力 41.63±16.08 47.07±21.50 0.456 0.148 听力提高 10.57±8.73 8.91±11.79 0.817 0.416 术前气骨导差 16.11±5.77 17.94±5.92 1.501 0.136 气骨导差下降 6.44±4.98 6.89±6.99 0.384 0.702
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