Gamra O Ben, Mbarek C, Khammassi K, Methlouthi N, Ouni H, Hariga I, Zribi S, Koubâa J, El Khedim A
Department of Otorhinolaryngology-Head and Neck Surgery, Habib Thameur Hospital, 8 Rue Ali Ben Ayed, Montfleury, 1008, Tunis, Tunisia.
Eur Arch Otorhinolaryngol. 2008 Jul;265(7):739-42. doi: 10.1007/s00405-008-0645-5. Epub 2008 Mar 20.
The aim of this study is to evaluate anatomical and audiological results of cartilage tympanoplasty compared to fascia tympanoplasty in the reconstruction of tympanic membrane perforations. We carry a retrospective study about 380 patients operated in our department between 1998 and 2005. Patients were classified into two groups: 90 (23.6%) undergo cartilage tympanoplasty and 290 (76.4%) fascia tympanoplasty. In each group, we calculated the average of pre and postoperative air bone gap (ABG) and the average air conduction gain (ACG) at 250-4,000 Hz. The surgical technique is explained in detail. We detail and analyze the audiological and anatomical results in each group. Successful closure of the tympanic membrane perforation was achieved in 97% of the cartilage group as compared to 94% of the fascia group. The average ACG was 21 +/- 11 dB in cartilage group and 20 +/- 22 dB in fascia group. With an average follow-up of 2 years, residual perforation was observed in 2.2% in cartilage group. Reperforation of fascia graft and retraction were noted in 2.1 and 1%, respectively. The authors show the great reliability of cartilage tympanoplasty to close tympanic membrane perforations. We recommend using cartilage as a first choice, especially in stable or evolutive chronic otitis media, and in recurrent perforation of the tympanic membrane.
本研究的目的是评估在鼓膜穿孔重建中，软骨鼓膜成形术与筋膜鼓膜成形术相比的解剖学和听力学结果。我们对1998年至2005年在我科接受手术的380例患者进行了回顾性研究。患者分为两组：90例（23.6%）接受软骨鼓膜成形术，290例（76.4%）接受筋膜鼓膜成形术。在每组中，我们计算了250 - 4000Hz术前和术后气骨导差（ABG）的平均值以及气导增益（ACG）的平均值。详细解释了手术技术。我们详细阐述并分析了每组的听力学和解剖学结果。软骨组鼓膜穿孔成功闭合率为97%，而筋膜组为94%。软骨组平均ACG为21±11dB，筋膜组为20±22dB。平均随访2年，软骨组残余穿孔率为2.2%。筋膜移植物再穿孔和内陷分别为2.1%和1%。作者表明软骨鼓膜成形术在闭合鼓膜穿孔方面具有很高的可靠性。我们建议将软骨作为首选，特别是在稳定或进展性慢性中耳炎以及鼓膜反复穿孔的情况下。
