Yilmaz Metin, Kemaloğlu Yusuf K, Aydil Utku, Bayramoğlu Ismet, Göksu Nebil, Ozbilen Suat
Gazi University, Faculty of Medicine, Department of ENT-HNS, Yalim Sokak 2/13K. Esat, Ankara 06660, Turkey.
Int J Pediatr Otorhinolaryngol. 2006 Jan;70(1):137-41. doi: 10.1016/j.ijporl.2005.06.002. Epub 2005 Jul 25.
Our purpose was to evaluate efficiency of immediate repair of the tympanic membrane perforation after intentional removal of the long-lasting tubes.
This study was done in 36 ears of 27 patients who had either Goode-T or Paparella-II silicone tube insertion due to chronic OME or ROM and tube removal. Only the ears in which tube removal was performed due to no longer need for middle ear ventilation were included to the study. After removal of the tube, the perforation edges were refreshed and Steri-Strip (3M) patch was adhered on the perforation site. Otoscopic, tympanometric and audiologic data were reported.
Mean duration of the tube persistence was 49.58+/-11.94 months. It was found that there were two subgroups in the study group: those under regular follow-up (20 ears), and the ears which were out of regular follow-up (16 ears). Mean tube persistence times were 34.10 and 52.11 months in these subgroups, respectively (chi2-test, p=0.056). In six ears (16.67%), persistent perforation (PP) was found. PP rate (PPR) was higher in group-B (25%) than in group-A (10%) (chi2-test, p>0.1). The rest perforation was anteriorly marginal in five of six PP (83.33%). The PPR in the ears in which rest perforation was anteriorly marginal was 35.71% (5/14) while it was 4.54% (1/22) in the ears with central rest perforation (chi2-test, p<0.02).
Even immediate repair of the perforation after removal of the long-lasting tubes resulted in a high PPR. The data in this study documented that this high PPR was associated with type and localisation of rest perforation and tube persistence time. Anteriorly, marginal perforations had about eight times higher risk of PP and longer tube persistence caused higher anterior marginal perforations after tube removal.
我们的目的是评估在有意取出长期置管后立即修复鼓膜穿孔的效果。
本研究纳入了27例患者的36耳，这些患者因慢性中耳炎或反复中耳炎发作而插入了古德-T型或帕帕雷拉-II型硅胶管，之后进行了取管操作。仅将因不再需要中耳通气而进行取管的耳纳入研究。取管后，修整穿孔边缘，并在穿孔部位粘贴3M Steri-Strip贴片。报告耳镜、鼓室图和听力学数据。
置管的平均持续时间为49.58±11.94个月。研究组发现有两个亚组：定期随访的耳（20耳）和未进行定期随访的耳（16耳）。这些亚组中的置管平均持续时间分别为34.10个月和52.11个月（卡方检验，p = 0.056）。在6耳（16.67%）中发现了持续性穿孔（PP）。B组的PP发生率（PPR）（25%）高于A组（10%）（卡方检验，p>0.1）。在6例PP中，有5例（83.33%）剩余穿孔位于前方边缘。剩余穿孔位于前方边缘的耳中PPR为35.71%（5/14），而中央剩余穿孔的耳中PPR为4.54%（1/22）（卡方检验，p<0.02）。
即使在取出长期置管后立即修复穿孔，PPR仍较高。本研究数据表明，这种高PPR与剩余穿孔的类型和位置以及置管持续时间有关。前方边缘穿孔发生PP的风险约高8倍，且置管持续时间越长，取管后前方边缘穿孔越高。
