Uzun Cem, Cayé-Thomasen Per, Andersen Janne, Tos Mirko
Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Gentofte University Hospital of Copenhagen, Denmark.
Laryngoscope. 2003 Oct;113(10):1751-7. doi: 10.1097/00005537-200310000-00017.
The aim of the present study is to compare the tympanometric and functional findings of cartilage palisade tympanoplasty with those of tympanoplasty with temporalis fascia grafting after one-stage surgery in children with tensa cholesteatoma.
In children aged 5 to 15 years (mean, 9.5 years) with tensa cholesteatoma, cartilage palisade tympanoplasty was performed in 32 ears and fascia tympanoplasty in 29 ears. Tympanometry was performed in 31 ears with cartilage palisade tympanoplasty (the palisade group) and 28 ears with fascia tympanoplasty (the fascia group) at follow-up a median of 48 months after surgical removal of the cholesteatoma (range, 3-75 months).
Postoperative perforations, tympanometric parameters (tympanogram type, compliance, tympanometric width), and hearing.
All postoperative re-perforations occurred in the fascia group. However, there was no difference between the palisade group and the fascia group in terms of tympanometric parameters, nor between the two groups when dividing into tensa retraction and sinus cholesteatoma subgroups. When comparing the types of tympanoplasty, the type II group reconstructed with cartilage palisades contained a higher number of ears with a normal compliance (0.2-1.6 mL) but a higher number of ears with a tympanometric width of more than 150 mmH2O. Regarding the number of ears with normal tympanometries, there was no significant difference between the palisade and the fascia group. The late functional hearing results were better in ears reconstructed with cartilage palisades, with functional success in 71%, compared with 54% in the group with fascia grafting. This difference in functional results was particularly pronounced in ears with an abnormal tympanogram (68% vs. 29%).
Compared to fascia grafting, the present study showed better late functional hearing results after drum reconstruction using cartilage palisades, despite comparable tympanometric findings. Cartilage palisade reconstruction seems to provide better functional results, especially in ears with a poor tubal function, which is the common situation after cholesteatoma surgery.
本研究旨在比较紧张部胆脂瘤患儿一期手术后，软骨栅栏式鼓室成形术与颞肌筋膜移植鼓室成形术的鼓室图及功能结果。
选取5至15岁（平均9.5岁）紧张部胆脂瘤患儿，32耳行软骨栅栏式鼓室成形术，29耳行筋膜鼓室成形术。在胆脂瘤手术切除后中位随访48个月（范围3 - 75个月）时，对31耳行软骨栅栏式鼓室成形术（栅栏组）和28耳行筋膜鼓室成形术（筋膜组）进行鼓室图检查。
术后穿孔情况、鼓室图参数（鼓室图类型、顺应性、鼓室图宽度）及听力。
所有术后再穿孔均发生在筋膜组。然而，栅栏组与筋膜组在鼓室图参数方面无差异，在分为紧张部内陷和鼓窦胆脂瘤亚组时两组之间也无差异。比较鼓室成形术类型时，用软骨栅栏重建的II型组中，顺应性正常（0.2 - 1.6 mL）的耳数较多，但鼓室图宽度超过150 mmH₂O的耳数也较多。关于鼓室图正常的耳数，栅栏组与筋膜组之间无显著差异。软骨栅栏重建耳的晚期功能听力结果更好，功能成功率为71%，而筋膜移植组为54%。这种功能结果的差异在鼓室图异常的耳中尤为明显（68%对29%）。
与筋膜移植相比，本研究表明，尽管鼓室图结果相当，但使用软骨栅栏进行鼓膜重建后晚期功能听力结果更好。软骨栅栏重建似乎能提供更好的功能结果，尤其是在咽鼓管功能不良的耳中，这是胆脂瘤手术后的常见情况。
