Prior M, Gibbins N, John G, Rhys-Williams S, Scott P
ENT Department, Derriford Hospital, Plymouth, UK.
J Laryngol Otol. 2008 Feb;122(2):e3. doi: 10.1017/S0022215107000965. Epub 2007 Dec 21.
To investigate the use of a new technique to close persistent tympanic membrane perforations under general anaesthesia, in patients in whom this has previously been considered impractical.
Twenty patients aged 50 years and over were recruited. All had a persistent, symptomatic tympanic membrane perforation in at least one ear. Pre-operatively, an audiogram was performed and the tympanic membrane was assessed in order to establish the site and size of the perforation. Under general anaesthesia, the edges of the perforation were freshened and a sheet of Epifilm, trimmed to a size roughly 2 mm larger in diameter than the perforation, was tucked through the perforation. The ear was dressed appropriately. Patients were seen two weeks post-operatively in the out-patients department and reassessed.
The study was based at Poole General Hospital, a District General Hospital.
Twenty patients were recruited from the out-patients clinics of Poole Hospital ENT department.
(1) closure of the perforation, as a percentage of the original size; (2) improvement of hearing, as an average across all frequencies, expressed in dB hearing level; and (3) presence or absence of discharge.
Five patients were operated upon and assessed six weeks post-operatively. The Epifilm had dissolved but the perforations remained the same size in all five patients. There were no other adverse effects. Pure tone audiometry at this stage was redundant. The study was subsequently aborted.
The authors conclude that repair of tympanic membrane perforations with hyaluronic acid ester films is not to be recommended.
探讨一种在全身麻醉下闭合持续性鼓膜穿孔的新技术在以往被认为不适用的患者中的应用。
招募了20名年龄在50岁及以上的患者。所有患者至少有一只耳朵存在持续性、有症状的鼓膜穿孔。术前进行听力图检查并评估鼓膜，以确定穿孔的部位和大小。在全身麻醉下，将穿孔边缘清理新鲜，然后将一片Epifilm修剪成直径比穿孔大约2毫米的尺寸，通过穿孔塞入。耳朵进行适当包扎。术后两周在门诊对患者进行复诊并重新评估。
该研究以普尔综合医院（一家地区综合医院）为基础。
从普尔医院耳鼻喉科门诊招募了20名患者。
（1）穿孔闭合情况，以占原始大小的百分比表示；（2）听力改善情况，以所有频率的平均值表示，单位为分贝听力水平；（3）有无耳漏。
5名患者接受手术并在术后6周进行评估。此时Epifilm已溶解，但所有5名患者的穿孔大小保持不变。没有其他不良反应。此时纯音听力测定已无必要。该研究随后中止。
作者得出结论，不推荐使用透明质酸酯膜修复鼓膜穿孔。
