Glasscock M E
Laryngoscope. 1976 Jan;86(1):70-6. doi: 10.1288/00005537-197601000-00015.
The two primary symptoms of chronic ear disease are otorrhea and hearing loss. The goal of any tympanoplasty is to eradicate disease and improve hearing. These are the primary indications for this procedure. The success or failure of the surgery is influenced by many factors such as the age and general health of the patient, the extent and type of disease present, and whether the upper airway is functioning properly. Contraindications to tympanoplasty will vary from one surgeon to another depending upon his training, philosophy, experience, and surgical skill. It is helpful to think of these contraindications as being either absolute or relative. Absolute contraindications consist of: 1. uncontrolled cholesteatoma; 2. malignant tumors; 3. unusual infections and/or extenuating circumstances; and 4. complications of chronic ear disease, such as meningitis, brain abscess, or lateral sinus thrombosis. Relative contraindications are less well defined: 1. eustachian tube insufficiency or non-function; 2. the uncooperative patient; 3. the dead ear; 4. the better hearing or only hearing ear; 5. the elderly patient; 6. the young child; and 7. the repeated failure case. The otologic surgeon must exercise good clinical judgment in selecting patients for tympanoplasty. This paper deals with some of the more common problems in decision making.
慢性耳病的两个主要症状是耳漏和听力损失。任何鼓室成形术的目标都是根除疾病并改善听力。这些是该手术的主要指征。手术的成败受许多因素影响，如患者的年龄和总体健康状况、现存疾病的范围和类型，以及上呼吸道功能是否正常。鼓室成形术的禁忌证因外科医生而异，取决于他的培训、理念、经验和手术技巧。将这些禁忌证分为绝对禁忌证和相对禁忌证会有所帮助。绝对禁忌证包括：1. 未控制的胆脂瘤；2. 恶性肿瘤；3. 特殊感染和/或情有可原的情况；4. 慢性耳病的并发症，如脑膜炎、脑脓肿或乙状窦血栓形成。相对禁忌证则定义不太明确：1. 咽鼓管功能不全或无功能；2. 不配合的患者；3. 死耳；4. 听力较好或唯一有听力的耳朵；5. 老年患者；6. 幼儿；7. 反复失败的病例。耳科外科医生在选择鼓室成形术患者时必须具备良好的临床判断力。本文探讨了一些决策中较为常见的问题。
