Lesinskas Eugenijus, Stankeviciute Vilma
Clinic of Ear, Nose, Throat and Eye Diseases, Faculty of Medicine, Vilnius University, Lithuania.
Auris Nasus Larynx. 2011 Apr;38(2):196-202. doi: 10.1016/j.anl.2010.07.010. Epub 2010 Oct 28.
To evaluate the success rate for revision tympanoplasty using different graft materials, to compare results of primary and re-tympanoplasty using the same technique and to analyse the effect of potential influencing factors on closure of tympanic membrane (TM) and hearing outcome.
Study included all patients, who underwent tympanoplasty (n=617) and re-tympanoplasty (n=94) for chronic otitis media without cholesteatoma in the period between September 1998 and 2007. The data of all patients on preoperative disease, perforation size and localization, middle ear status, surgical approach, graft material, adjunctive procedures, pre- and postoperative morphological (otomicroscopy) and functional (hearing examination evaluating pure-tone audiogram) results were analyzed. All operations were performed using an underlay technique and either the retroauricular or transcanal approach. The temporal fascia, perichondrium or cartilage-perichondrium composite grafts were used for the reconstruction of TM. Ossiculoplasty was performed as needed. The interrelation between multiple pre-operative parameters and post-operative morphological (closure of the perforation) and functional (hearing level) outcomes was analysed.
Successful closure rates of the TM perforation were 93.6% and 90.2% of the patients in the primary and revision tympanoplasty groups, respectively. Graft take rate and hearing results did not depend on graft material. Structural changes were found more frequently in the re-tympanoplasty group (63.4% comparing to 29.5% of primary cases). Ossiculoplasty was performed more often in revision cases (24.4% comparing to 11.4% of primary cases). Successful hearing (ABG within 20dB) for primary tympanoplasties was achieved in 81.1%, and for retympanoplasty - in 69.5% of the cases. (p<0.01). There were no interrelation between any estimated parameters and the graft take rate for either primary or revision tympanoplasty.
There is no evidence of increased risk of graft failure in re-tympanoplasty cases when compared to primary tympanoplasty operations. Hearing results depend on structural changes in the middle ear (ossicular abnormalities and tympanoscerosis) which in revision cases are found more often. No differences were found between fascia, perichondrum or cartilage-perichondrium grafts in terms of graft healing and hearing results.
评估使用不同移植物材料进行鼓室成形术翻修的成功率，比较采用相同技术进行初次鼓室成形术和再次鼓室成形术的结果，并分析潜在影响因素对鼓膜（TM）闭合及听力结果的影响。
研究纳入了1998年9月至2007年期间因非胆脂瘤性慢性中耳炎接受鼓室成形术（n = 617）和再次鼓室成形术（n = 94）的所有患者。分析了所有患者术前疾病、穿孔大小和位置、中耳状况、手术入路、移植物材料、辅助手术、术前和术后形态学（耳显微镜检查）及功能学（评估纯音听力图的听力检查）结果。所有手术均采用夹层技术，采用耳后或经耳道入路。颞肌筋膜、软骨膜或软骨 - 软骨膜复合移植物用于TM重建。根据需要进行听骨链成形术。分析了多个术前参数与术后形态学（穿孔闭合）和功能学（听力水平）结果之间的相互关系。
初次鼓室成形术组和再次鼓室成形术组患者TM穿孔的成功闭合率分别为93.6%和90.2%。移植物成活率和听力结果不取决于移植物材料。再次鼓室成形术组结构改变的发生率更高（63.4%，而初次手术病例为29.5%）。再次手术病例中听骨链成形术的实施频率更高（24.4%，而初次手术病例为11.4%）。初次鼓室成形术成功听力（气骨导差在20dB以内）的比例为81.1%，再次鼓室成形术为69.5%。（p<0.01）。对于初次或再次鼓室成形术，任何评估参数与移植物成活率之间均无相关性。
与初次鼓室成形术相比，没有证据表明再次鼓室成形术病例中移植物失败的风险增加。听力结果取决于中耳的结构改变（听骨链异常和鼓室硬化），再次手术病例中这种改变更常见。在移植物愈合和听力结果方面，颞肌筋膜、软骨膜或软骨-软骨膜移植物之间未发现差异。
