Lee Heung-Yeup, Auo Hyeon-Jin, Kang Jun-Myung
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Auris Nasus Larynx. 2010 Apr;37(2):162-6. doi: 10.1016/j.anl.2009.06.002. Epub 2009 Aug 19.
To report our experience with "loop overlay" tympanoplasty, a modified overlay technique with a superiorly based skin flap, for the reconstruction of anterior, subtotal or total tympanic membrane (TM) perforations.
Retrospective review of patients undergoing loop overlay tympanoplasty from March 1998 to February 2007 was performed. Four hundred and twenty-nine patients who underwent loop overlay tympanoplasty and then follow-up visits a minimum of 6 months later were included in this study. Hearing test results were reported using a four-frequency (0.5, 1, 2, and 3kHz) pure tone average air-bone gap. The outcome was considered successful if the TM was intact without lateralization or anterior blunting after the follow-up visit.
There was a 98.8% success rate. There was no graft lateralization, anterior blunting, neocholesteatoma, or sensorineural hearing loss. The mean preoperative to postoperative four-tone air-bone gap improved from 23.5 to 8.1dB, which is a mean gain of 15dB; this was statistically significant (p<0.001, paired sample t-test).
The loop overlay graft method is a safe and effective technique for reconstruction of anterior, subtotal or total TM perforations, with excellent graft take and significant improvement of hearing. It provides a precise replacement of the flap and a preserved healing plane.
报告我们采用“环形覆盖”鼓室成形术（一种改良的覆盖技术，采用蒂位于上方的皮瓣）重建鼓膜前侧、次全或全层穿孔的经验。
对1998年3月至2007年2月期间接受环形覆盖鼓室成形术的患者进行回顾性研究。本研究纳入了429例行环形覆盖鼓室成形术且术后至少随访6个月的患者。听力测试结果采用四频率（0.5、1、2和3kHz）纯音平均气骨导差报告。如果随访后鼓膜完整，无外凸或前侧变钝，则认为手术结果成功。
成功率为98.8%。未出现移植物外凸、前侧变钝、新胆脂瘤或感音神经性听力损失。术前至术后的平均四频率气骨导差从23.5dB改善至8.1dB，平均改善15dB；差异具有统计学意义（p<0.001，配对样本t检验）。
环形覆盖移植物法是一种安全有效的技术，用于重建鼓膜前侧、次全或全层穿孔，移植物成活率高，听力有显著改善。它能精确替换皮瓣并保留愈合平面。
