Adkins A P, Friedman Ellen M
2225 County Road 90, Suite 123, Pearland, TX 77584, USA.
Int J Pediatr Otorhinolaryngol. 2005 Aug;69(8):1047-51. doi: 10.1016/j.ijporl.2005.01.032.
To evaluate factors affecting perforation healing in children with surgical removal of retained tympanostomy tubes.
We conducted a retrospective chart review of 82 pediatric patients (111 ears) who underwent surgical tube removal at a tertiary care pediatric hospital from 1/1/1999 to 12/31/2001. Patients included 47 males and 35 females with an age range of 2-15 years (average age, 6.8 years and median, 6 years). The length of intubation ranged from 12 months to 108 months (average, 44.6 months). The indications for removal included: prolonged intubation (61.3%), otorrhea or recurrent infection (21.6%), obstruction (7.2%), tube in middle ear (6.3%), enlarging perforation (2.7%), and in preparation for future cochlear implant surgery (9.9%). Interventions included removal of tympanostomy tubes and techniques for encouraging perforation closure. Seventy-six percent of the ears had a technique used to encourage healing. These techniques included freshen edges (11.8%), Gelfoam or Gelfilm (14.1%), Gelfoam and/or Gelfilm with freshened edges (50.6%). The main outcome measure was perforation healing. Chi-square statistical analysis were used to determine the statistical significant of observations.
Overall closure rate for all patients available for follow up was 87.0%, regardless of technique used to encourage healing. There was no statistically significant difference between the average intubation time in ears that healed (44 months), versus those with persistent perforation after removal (42 months). There was no statistical significant difference in closure rate based on patient age. When tubes were removed for prolonged intubation, 87.0% closed. If the indication was otorrhea or recurrent infections, 93.0% healed.
The overwhelming majority of patients who undergo surgical removal of tubes will show complete tympanic membrane healing independent of technique at time of removal, duration of intubation, patient age, or indication for removal.
评估影响行鼓膜置管取出术的儿童鼓膜穿孔愈合的因素。
我们对1999年1月1日至2001年12月31日在一家三级儿科医院接受鼓膜置管取出术的82例儿科患者（111只耳）进行了回顾性病历审查。患者包括47名男性和35名女性，年龄范围为2至15岁（平均年龄6.8岁，中位数6岁）。置管时间从12个月至108个月不等（平均44.6个月）。取出置管的指征包括：置管时间延长（61.3%）、耳漏或反复感染（21.6%）、堵塞（7.2%）、中耳内有置管（6.3%）、穿孔扩大（2.7%）以及为未来的人工耳蜗植入手术做准备（9.9%）。干预措施包括取出鼓膜置管以及促进穿孔闭合的技术。76%的耳采用了促进愈合的技术。这些技术包括修整边缘（11.8%）、使用明胶海绵或明胶膜（14.1%）、使用明胶海绵和/或明胶膜并修整边缘（50.6%）。主要观察指标是穿孔愈合情况。采用卡方统计分析来确定观察结果的统计学显著性。
所有可供随访患者的总体闭合率为87.0%，无论采用何种促进愈合的技术。愈合耳的平均置管时间（44个月）与取出后置管仍持续穿孔耳的平均置管时间（42个月）之间无统计学显著差异。基于患者年龄的闭合率无统计学显著差异。因置管时间延长而取出置管时，87.0%的穿孔闭合。如果指征是耳漏或反复感染，93.0%的穿孔愈合。
绝大多数接受鼓膜置管取出术的患者鼓膜会完全愈合，与取出时采用的技术、置管时间、患者年龄或取出指征无关。
