Hartzell Larry D, Dornhoffer John L
Department of Otolaryngology/Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
Curr Opin Otolaryngol Head Neck Surg. 2010 Dec;18(6):550-3. doi: 10.1097/MOO.0b013e32833febc4.
Children with chronic otitis media with effusion resulting in repeat ventilation tube placement are at increased risk for perforation, an atelectatic ear, cholesteatoma, and hearing loss. The timing of intervention is controversial, and management strategies are variable. This update reviews the recent literature with a focus on groups at greater risk for requiring tympanoplasty, such as patients with craniofacial abnormalities including cleft palate and Down syndrome.
Patient age continues to show a debatable relationship to tympanoplasty success. The use of cartilage grafts shows equivalent results compared with traditional techniques. Cartilage provides a more robust scaffold, which can improve outcomes in difficult ears. Patients with cleft palate or Down syndrome have a significantly increased risk of Eustachian tube dysfunction and commonly require tympanoplasty, which necessitates careful consideration of timing and technique.
The timing of tympanoplasty is still under debate, with little concrete evidence to indicate absolute guidelines. Attention to patient age, craniofacial abnormalities, and graft choice will help to improve surgical success.
患有慢性中耳积液并导致反复放置通气管的儿童，发生鼓膜穿孔、肺不张性耳、胆脂瘤和听力损失的风险增加。干预时机存在争议，管理策略也各不相同。本综述回顾了近期文献，重点关注需要进行鼓室成形术风险较高的人群，如患有包括腭裂和唐氏综合征在内的颅面畸形的患者。
患者年龄与鼓室成形术成功之间的关系仍有争议。与传统技术相比，使用软骨移植显示出相同的结果。软骨提供了更坚固的支架，可以改善难处理耳朵的手术效果。腭裂或唐氏综合征患者咽鼓管功能障碍的风险显著增加，通常需要进行鼓室成形术，这需要仔细考虑手术时机和技术。
鼓室成形术的时机仍在争论中，几乎没有具体证据表明绝对的指导原则。关注患者年龄、颅面畸形和移植材料的选择将有助于提高手术成功率。
