Schraff Scott A, Markham Jeffrey, Welch Camille, Darrow David H, Derkay Craig S
Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA 23507-1914, USA.
Am J Otolaryngol. 2006 Jul-Aug;27(4):238-43. doi: 10.1016/j.amjoto.2005.11.007.
The objective of this study was to examine the success of a pilot treatment algorithm for tympanic membrane perforations in children after tympanostomy tube placement.
A retrospective chart review of children with diagnosed tympanic membrane perforations after tympanostomy tube placement from 1998 to 2003 at a tertiary care children's hospital was performed. The patients had been treated according to an algorithm used by 2 pediatric otolaryngologists for management of tympanic membrane perforations: observation vs myringoplasty. Success rates were examined.
Ninety-five children were identified, 27% of whom had nonhealing perforations after tube extrusion; 73% of the perforations were caused by a retained tube. The median duration of tube retention was 48 months, ranging from 13 to 120 months. After the treatment protocol, 76% of the patients underwent gelatin film or paper patch myringoplasty, 23% had adipose myringoplasty, and 1% were observed. Overall, 91% had healed perforations after the first intervention. Among those requiring a second intervention, the sizes of initial perforations were between 15% and 40%, with postrepair perforation sizes between 5% and 40%. In addition, 75% of those requiring a second intervention underwent tympanoplasty repair and 25% had fat patch myringoplasty. None required a third intervention.
Our treatment algorithm for children with tympanic membrane perforations after tympanostomy tube placement appears to be successful and is an excellent model for other clinicians.
本研究的目的是检验一种针对儿童鼓膜置管术后鼓膜穿孔的试验性治疗方案的成功率。
对一家三级儿童专科医院1998年至2003年期间诊断为鼓膜置管术后鼓膜穿孔的儿童进行回顾性病历审查。这些患者按照两位儿科耳鼻喉科医生用于处理鼓膜穿孔的方案进行治疗：观察与鼓膜成形术。检查成功率。
共识别出95名儿童，其中27%在耳管脱出后有未愈合的穿孔；73%的穿孔是由残留耳管引起的。耳管留置的中位时间为48个月，范围从13个月至120个月。按照治疗方案，76%的患者接受了明胶膜或纸片修补鼓膜成形术，23%接受了脂肪鼓膜成形术，1%进行了观察。总体而言，91%的患者在首次干预后穿孔已愈合。在需要第二次干预的患者中，初始穿孔大小在15%至40%之间，修复后穿孔大小在5%至40%之间。此外，需要第二次干预的患者中，75%接受了鼓室成形术修复，25%进行了脂肪贴片鼓膜成形术。无人需要第三次干预。
我们针对鼓膜置管术后鼓膜穿孔儿童的治疗方案似乎是成功的，对其他临床医生来说是一个很好的范例。
