Lou Zheng-Cai, Hu Yun-Xing, Tang Yong-Mei
Department of Otorhinolaryngology, Yiwu Central Hospital, Zhejiang, China.
ORL J Otorhinolaryngol Relat Spec. 2011;73(4):212-8. doi: 10.1159/000329705. Epub 2011 Jul 13.
This study aimed to retrospectively evaluate the prognosis and outcome of tympanic membrane perforations with a particular focus on the fate of the perforation edge flaps.Chart records of 329 patients with a single ear traumatic tympanic membrane perforation were retrieved and analyzed. Of these patients, 70 were left to heal spontaneously, 93 received gelatin sponge patching treatment and 114 were subjected to otoendoscopic eardrum repair before gelatin sponge patching. The complete perforation closure rate at 3 months was 94.29% (66/70), 98.92% (92/93) and 98.24% (112/114) in the 3 groups, respectively, with no statistically significant difference (p = 0.608). The mean closure time was 28.2 ± 3.6 days in the spontaneous healing group, which was significantly longer than that in the sponge patching group (11.1 ± 2.1 days, p = 0.0017) and in the eardrum repair + sponge patching group (12.5 ± 1.9 days, p = 0.0032), while there was no significant difference between the 2 gelatin sponge patching groups (p = 1.86). The hearing ability improved in the 3 groups (6.4 ± 0.83, 7.2 ± 1.65 and 9.6 ± 2.37 dB, respectively), with no statistically significant difference (p >0.05). In the gelatin sponge patching group, new tympanic membrane tissue of the eardrum flap edge proliferated, and the contour of the eardrum flap was not obvious. In the eardrum flap repair group, the eardrum flap retracted to the perforation edge. In conclusion, the eardrum flap of the perforation edge does not have any obvious effect on the perforation closure so that it is unnecessary to conduct an intervention procedure on the flap in the clinical treatment.
本研究旨在回顾性评估鼓膜穿孔的预后及转归，特别关注穿孔边缘皮瓣的转归情况。检索并分析了329例单耳外伤性鼓膜穿孔患者的病历记录。其中，70例患者任其自行愈合，93例接受了明胶海绵修补治疗，114例在明胶海绵修补前接受了耳内镜下鼓膜修补术。3组患者在3个月时的完全穿孔闭合率分别为94.29%（66/70）、98.92%（92/93）和98.24%（112/114），差异无统计学意义（p = 0.608）。自行愈合组的平均闭合时间为28.2±3.6天，显著长于海绵修补组（11.1±2.1天，p = 0.0017）和鼓膜修补+海绵修补组（12.5±1.9天，p = 0.0032），而两个明胶海绵修补组之间差异无统计学意义（p = 1.86）。3组患者的听力均有改善（分别为6.4±0.83、7.2±1.65和9.6±2.37 dB），差异无统计学意义（p>0.05）。在明胶海绵修补组中，鼓膜皮瓣边缘有新的鼓膜组织增生，鼓膜皮瓣轮廓不明显。在鼓膜皮瓣修补组中，鼓膜皮瓣回缩至穿孔边缘。综上所述，穿孔边缘的鼓膜皮瓣对穿孔闭合无明显影响，因此在临床治疗中无需对皮瓣进行干预操作。
