Department of Otolaryngology and Head and Neck Surgery, University Hospital NORD, Université de la Méditerranée and Assistance Publique Hôpitaux de Marseille, Marseille Cedex, France.
Otol Neurotol. 2010 Feb;31(2):220-4. doi: 10.1097/MAO.0b013e3181c9960d.
To describe the rehabilitation of canal wall down mastoidectomy cavities using a custom-made titanium wall implant and to analyze the benefits and the long-term functional results.
Retrospective analysis.
Tertiary care center.
We have reviewed the data of 113 consecutive operated ears from 106 patients during a 9-year period (1993-2002). The following preoperative and postoperative criteria were compared: the persistence or resolution of otorrhea, cholesteatoma, and vertigo; external auditory canal healing, position of the titanium prosthesis, and tympanic membrane findings. In addition, the hearing status was evaluated by comparing the preoperative data with the 6-month and last follow-up postoperative data to deduce the air-bone gap (ABG) and the auditory gains.
Operated ears (88.5%) were dry after the initial rehabilitation, and 97.3% were dry after a revision surgery for defective canal healing. Most patients (96.5%) were free of vertigo. The external auditory canal wall was in a good position in all cases and allowed for a primary skin healing process in 84% of cases; the remaining patients underwent revision surgery under local anesthesia to complete the healing. The reconstructed drum was stable and anatomic in 73% of the cases (n = 83) after the first surgery. Thirty-six patients (32%) underwent various revision procedures: aeration tube placement for 16 patients with mesotympanic retraction and/or serous effusion, revision surgery for 12 patients with attic retraction or evidence of cholesteatoma, and revision for 5 patients with perforation. At last follow-up, 100% of the ear canals were healed, and 85% of patients had a normal tympanic membrane. No residual cholesteatoma was found at last follow-up. Thirty-six percent of patients had an ABG within 20 dB at last follow-up, and 69% within 30 dB.
The rehabilitation of canal wall down mastoidectomies improves the quality of life of patients regarding cholesteatoma recurrence, otorrhea, and vertigo in more than 95% of cases and stabilizes the hearing loss to less than 30 dB of ABG for more than two thirds of patients. The main unresolved problem is the persistent dysfunction of the middle ear cavity, with unsatisfactory auditory improvements. Middle ear implants represent in selected cases a new solution to rehabilitate the refractory hearing losses.
描述使用定制钛壁植入物对完壁式乳突切除术腔进行修复，并分析其益处和长期功能结果。
回顾性分析。
三级护理中心。
我们回顾了 106 例患者的 113 例连续手术耳在 9 年期间（1993-2002 年）的数据。比较了以下术前和术后标准：耳漏、胆脂瘤和眩晕的持续或缓解；外耳道愈合、钛假体位置和鼓膜情况。此外，通过比较术前数据与术后 6 个月和最后随访的术后数据，评估听力状况，得出气骨导差（ABG）和听力增益。
初次修复后，88.5%的手术耳干燥，87.5%的手术耳干燥；97.3%的手术耳在修复不良的外耳道愈合后干燥。大多数患者（96.5%）无眩晕。所有病例的外耳道壁位置良好，84%的病例可实现原发性皮肤愈合过程；其余患者在局部麻醉下接受了修复手术以完成愈合。初次手术后，73%的病例（n=83）鼓膜稳定且解剖结构正常。36 例（32%）患者接受了各种修复手术：16 例患者因中鼓室回缩和/或浆液性渗出而行通气管放置术，12 例患者因鼓室后上隐窝回缩或胆脂瘤证据而行修复手术，5 例患者因穿孔而行修复手术。最后随访时，100%的外耳道愈合，85%的患者鼓膜正常。最后随访时未发现残留胆脂瘤。36%的患者最后随访时 ABG 为 20dB 以内，69%的患者为 30dB 以内。
完壁式乳突切除术的修复可改善 95%以上患者的生活质量，降低胆脂瘤复发、耳漏和眩晕的发生率，使 2/3 以上患者的听力损失稳定在 30dB 的 ABG 以内。主要未解决的问题是中耳腔持续功能障碍，听力改善不理想。中耳植入物在某些情况下为修复难治性听力损失提供了新的解决方案。
