Diacova Svetlana, McDonald Thomas J
Department of Otorhinolaryngology--Head and Neck Surgery, State Medical and Pharmaceutical University N. Testemitanu, Chisinau, Moldova.
Ear Nose Throat J. 2007 Sep;86(9):552-4.
We obtained the charts of 183 patients (197 ears) who had undergone surgery for chronic otitis media (COM), and we reviewed their otic histories to analyze the series of events that ultimately culminated in surgery. All ears had originally been treated for otitis media with effusion (OME); 125 ears had been treated with tympanostomy tube placement, and 72 ears had been treated with conservative measures. Our goal was to compare the influence that these two strategies had on the subsequent development of COM and its sequelae (i.e., retraction pockets, tympanic membrane perforations, and cholesteatomas) and thereby determine which strategy is preferable. We found that although retraction pockets developed in a significantly higher proportion of the tympanostomy-treated ears than the conservatively treated ears (58 vs. 35%; p < 0.01), a significantly greater percentage of retractions in the tympanostomy-treated ears were mild and situated in the anterior part of the tympanic membrane (52 vs. 32%; p < 0.05). Moreover, severe retractions were significantly more common in the conservatively treated ears (40 vs. 16%; p < 0.02); the incidence of complete retractions in the two groups of ears was similar (tympanostomy: 32%; conservative treatment: 28%). Cholesteatomas developed in a significantly lower percentage of tympanostomy-treated ears (67 vs. 81%; p < 0.05), and the incidence of large cholesteatomas that involved the tympanic and mastoid cavities was likewise significantly lower in these ears (44 vs. 69%; p < 0.05). There was no significant difference in the incidence of tympanic membrane perforations. Finally, even though all of these ears eventually required surgery for COM, the tympanostomy-treated ears required significantly fewer repeat surgeries (16 vs. 28%; p < 0.05) and significantly fewer radical modified tympanomastoidectomies (30 vs. 44%; p < 0.05). Therefore, we conclude that myringotomy with insertion of tympanostomy tubes to treat OME is superior to conservative treatment.
我们获取了183例（197耳）接受慢性中耳炎（COM）手术患者的病历，并回顾其耳部病史，以分析最终导致手术的一系列事件。所有耳朵最初均接受过分泌性中耳炎（OME）治疗；125耳接受过鼓膜置管治疗，72耳接受过保守治疗。我们的目标是比较这两种策略对COM及其后遗症（即内陷袋、鼓膜穿孔和胆脂瘤）后续发展的影响，从而确定哪种策略更可取。我们发现，尽管鼓膜置管治疗的耳朵中出现内陷袋的比例显著高于保守治疗的耳朵（58%对35%；p<0.01），但鼓膜置管治疗的耳朵中轻度且位于鼓膜前部的内陷比例显著更高（52%对32%；p<0.05）。此外，严重内陷在保守治疗的耳朵中显著更常见（40%对16%；p<0.02）；两组耳朵中完全内陷的发生率相似（鼓膜置管：32%；保守治疗：28%）。胆脂瘤在鼓膜置管治疗的耳朵中发生率显著更低（67%对81%；p<0.05），累及鼓室和乳突腔的大胆脂瘤在这些耳朵中的发生率同样显著更低（44%对69%；p<0.05）。鼓膜穿孔的发生率没有显著差异。最后，尽管所有这些耳朵最终都需要进行COM手术，但鼓膜置管治疗的耳朵需要的再次手术显著更少（16%对28%；p<0.05），根治性改良鼓室乳突切除术也显著更少（30%对44%；p<0.05）。因此，我们得出结论，鼓膜切开并插入鼓膜置管治疗OME优于保守治疗。
