Dawes Patrick J D, Leaper Matthew
Department ORL-HNS, Dunedin Hospital, University of Otago, 201 Great King Street, Dunedin, New Zealand.
Int J Pediatr Otorhinolaryngol. 2004 Feb;68(2):143-8. doi: 10.1016/j.ijporl.2003.09.012.
Following surgery for retraction pocket/cholesteatoma there is risk of residual disease, after canal wall up surgery a second look tympanotomy is routinely recommended. After canal wall down (CWDM) surgery this is not routine. In certain situations the senior author recommends second look tympanotomy. This report examines the outcome of this management paradigm applied to small cavity mastoid surgery for children.
A retrospective review of small cavity mastoid surgery for children with cholesteatoma or discharging retraction pocket disease. The primary procedure and surgical findings at second look tympanotomy are reported as well as the pre- and 1 year post-operative air and bone conduction thresholds and air-bone gap averaged across frequencies 0.5, 1, 2 and 4kHz and the mean pre- and post-operative bone conduction threshold at 4kHz. A Student t-test was used to compare hearing results.
Forty five were children reviewed at 1 year. Twelve (27%) were recommended second look tympanotomy, of which 10 had surgery; all were free of residual disease. At second look two children had ossiculoplasty performed, four had adhesions divided. Six children had formed a myringostapediopexy after their first surgery. The mean pre-op bone conduction threshold was 6.3dB for those having single stage surgery and 5.6dB for those having a second look and the post-operative thresholds were 7.8 and 10.2dB, respectively. The mean preoperative air conduction threshold was 32.6dB for single stage surgery and 31.1dB for staged surgery and at 1 year 29.2 and 40.8dB. This was a significant difference. After second look, the air conduction threshold was 34.5dB, and not significantly different from those who had single stage surgery. The mean pre-treatment 4kHz bone conduction threshold was 6.3 and 5.6dB for single stage surgery and second look tympanotomy and after surgery, respectively, 9.8 and 14.5dB. These changes are not statistically significant.
The small cavity mastoidectomy approach allows meticulous removal of disease from the middle ear and for certain indications second look tympanotomy is recommended. Planned second look tympanotomy has demonstrated excellent early disease control as well as allowing timely management of any pathology affecting the middle ear sound transformation mechanism.
在进行收缩袋/胆脂瘤手术后存在残留疾病的风险，在开放式乳突手术（保留外耳道后壁）后，通常建议进行二次探查鼓室切开术。在开放式乳突根治术（CWDM）后，这并非常规操作。在某些情况下，资深作者建议进行二次探查鼓室切开术。本报告探讨了这种管理模式应用于儿童小腔乳突手术的结果。
对患有胆脂瘤或有引流的收缩袋疾病的儿童进行小腔乳突手术的回顾性研究。报告了初次手术及二次探查鼓室切开术的手术结果，以及术前、术后1年0.5、1、2和4kHz频率的平均气导和骨导阈值及气骨导间距，以及4kHz频率的平均术前和术后骨导阈值。采用Student t检验比较听力结果。
45名儿童在术后1年接受复查。12名（27%）被建议进行二次探查鼓室切开术，其中10名接受了手术；所有患者均无残留疾病。二次探查时，2名儿童进行了听骨链成形术，4名儿童分离了粘连。6名儿童在首次手术后形成了鼓膜镫骨固定。接受一期手术的患者术前平均骨导阈值为6.3dB，接受二次探查的患者为5.6dB，术后阈值分别为7.8dB和10.2dB。一期手术术前平均气导阈值为32.6dB，分期手术为31.1dB，术后1年分别为29.2dB和40.8dB。这是一个显著差异。二次探查后，气导阈值为34.5dB，与接受一期手术的患者无显著差异。一期手术和二次探查鼓室切开术术前4kHz骨导阈值分别为6.3dB和5.6dB，术后分别为9.8dB和14.5dB。这些变化无统计学意义。
小腔乳突切除术能够精细地清除中耳疾病，对于某些适应证，建议进行二次探查鼓室切开术。计划性二次探查鼓室切开术已证明能实现良好的早期疾病控制，并能及时处理任何影响中耳声音转换机制的病变。
