Tympanoplasty with and without mastoidectomy for the treatment of active efficacy analysis of chronic suppurative otitis media of simple type
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摘要: 目的 分析鼓室成形术伴与不伴乳突切开治疗活动期单纯型慢性化脓性中耳炎(chronic suppurative otitis media，CSOM)的手术疗效及安全性，探讨在活动期CSOM鼓室成形术中是否可以避免开放乳突。方法 回顾性分析55例(55耳)活动期CSOM患者的临床资料，根据患者乳突及上鼓室发育情况，将有条件完成完壁式乳突切开术的患者为A组(30例)，行鼓室成形术联合完壁式乳突切开术。无条件完成完壁式乳突切开术的患者为B组(25例)采用去除部分盾板骨质后通畅中、上鼓室及鼓窦引流，同时完成鼓室成形术。比较2组患者术后3个月鼓膜移植成活率、手术前后的听力情况及再穿孔等并发症情况。结果 活动期CSOM患者术后整体鼓膜成活率为96.4%(53/55)，其中A组为96.7%；B组为96.0%，2组患者鼓膜成活率差异无统计学意义(P>0.05)。2组患者术后平均气骨导差值(ABG)较术前均有明显缩小，但2组患者ABG增益差异无统计学意义(P>0.05)。所有患者术后均无周围性面瘫、脑脊液漏、感音神经性聋等严重不良情况。结论 显微镜下采用通畅中上鼓室、鼓窦引流后的鼓室成形术治疗CSOM可获得满意的鼓膜成活率和听力提高疗效。且减少患者的创伤，防止因磨除乳突骨质后发生乳突区皮肤凹陷等并发症，缩短手术前的等待时间。Abstract: Objective To analyze the surgical efficacy and safety of tympanoplasty with and without mastoidectomy for the treatment of active simple chronic suppurative otitis media(CSOM), and to investigate whether mastoidectomy can be avoided in tympanoplasty for active CSOM.Methods The clinical data of 55 patients(55 ears) with active CSOM were retrospectively analyzed. Based on the development of the mastoid process and the upper tympanic chamber, patients who met the criteria for wall-up mastoidectomy were classified as group A (30 patients), and underwent tympanoplasty combined with wall-up mastoidectomy. Patients who did not meet the criteria for wall-up mastoidectomy were classified as group B(25 cases), and underwent tympanoplasty with the opening of the middle and upper tympanic chambers and sinus drainage after partial removal of the shield plate bone. The survival rate of tympanic membrane grafts, hearing before and after surgery, and complications such as reperforation were compared between the two groups at 3 months postoperatively.Results The overall postoperative tympanic membrane survival rate of patients with active CSOM was 96.4%(53/55), including 96.7% in group A; 96.0% in group B. There was no significant difference in the tympanic membrane survival rate between the two groups(P>0.05). The postoperative mean air-bone gap(ABG) was significantly reduced in both groups compared with the preoperative period, but there was no significant difference in ABG gain between the two groups(P>0.05). No patients experienced serious adverse conditions such as peripheral facial paralysis, cerebrospinal fluid leakage, or sensorineural deafness after surgery.Conclusion Microscopic tympanoplasty with patency of the middle and upper tympanic chambers and tympanic sinus drainage can be used to treat active simple chronic otitis media with satisfactory tympanic membrane viability and hearing improvement efficacy. This approach reduces patient trauma, prevents complications such as skin depressions in the mastoid area due to abrasion of the mastoid bone, and shortens the waiting time before surgery.
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Key words:
- active chronic otitis media /
- mastoidectomy
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表 1 手术前后2组患者的听力状况
dB HL，X±S 时间 对照组(n=30) 试验组(n=25) 平均气导 平均骨导 平均ABG 平均气导 平均骨导 平均ABG 术前 53.75±12.31 26.79±9.45 26.96±6.55 51.85±18.04 26.90±13.29 24.95±9.68 术后 40.42±12.63 27.36±9.84 13.04±5.21 38.95±18.43 27.65±14.44 11.30±6.53 
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表 2 2组患者手术前后ABG及ABG增益
dB HL，X±S 项目 对照组(n=30) 试验组(n=25) t P 术前平均ABG 26.96±6.55 24.95±9.68 0.914 0.365 术后平均ABG 13.04±5.21 11.30±6.53 1.101 0.276 ABG增益 13.92±6.67 13.65±7.94 0.135 0.893
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