Song Yu, Ma Furong
Department of Otorhinolaryngology-Head and Neck Surgery, Third Hospital of Peking University, Beijing 100191, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2012 May;26(9):404-7.
To investigate on the Indication and quality of life of the canal wall up and canal wall down surgery in chronic suppurative otitis media, to provide reference for surgical options.
The clinical data of patients underwent canal wall up or canal wall down surgery are analyzed. Follow up on 312 patients are accomplished with pure tone audiometry, acoustic impedance for surgical cavity volume, ear endoscopy and the Chinese chronic ear survey (CCES).
(1) The dry ear rate of canal wall up and canal wall down surgery are 98.7% and 98.6% respectively (P > 0.05). (2) The average cavity epithelization and dry ear time are 40.1 +/- 21.2 days for canal wall up surgery and 53.5 +/- 15.0 days for canal wall down surgery (P < 0.05). The postoperative ear volume to the contralateral normal ear volume ratio are 1.16 +/- 0.10 for canal wall up surgery and 2.05 +/- 1.19 for canal wall down surgery (P < 0.05). (4) Score of the CCES: 91.2 +/- 6.8 points for canal wall up surgery and 72.0 +/- 7.7 for canal wall down surgery (P < 0.05). (5) The proportion of patients feeling change of ear appearance is 5.7% for canal wall up surgery and 80.8% for canal wall down surgery (P < 0.05). (6) Hearing after surgery: objective hearing improvement rate is 58.9% for canal wall up surgery and 24.2% for canal wall down surgery (P < 0.05) according to the questionnaire, while the pure tone audiometry shows no significant difference in hearing thresh hold and air-bone gap. (7) The satisfactory score after surgery is 9.55 points for canal wall up surgery and 8.11 points for canal wall down surgery (P < 0.05).
(1) Patients underwent canal wall up surgery have near-normal external ear morphology, shorter dry ear time and much higher quality of life compared to canal wall down surgery. (2) For experienced ear surgeon, the indication for canal wall up surgery can be extended to cases with diploetic or sclerotic type of mastoid and part of the cases with anatomical variation and intracranial or extracranial complications.
探讨慢性化脓性中耳炎上鼓室保留术和上鼓室开放术的适应证及生活质量，为手术选择提供参考。
分析接受上鼓室保留术或上鼓室开放术患者的临床资料。对312例患者进行纯音听力测试、声阻抗检查以评估术腔容积、耳内镜检查及中国慢性中耳炎调查问卷（CCES）随访。
（1）上鼓室保留术和上鼓室开放术的干耳率分别为98.7%和98.6%（P>0.05）。（2）上鼓室保留术的术腔上皮化及干耳平均时间为40.1±21.2天，上鼓室开放术为53.5±15.0天（P<0.05）。上鼓室保留术术后术耳与对侧正常耳容积比为1.16±0.10，上鼓室开放术为2.05±1.19（P<0.05）。（4）CCES评分：上鼓室保留术为91.2±6.8分，上鼓室开放术为72.0±7.7分（P<0.05）。（5）感觉耳部外观有变化的患者比例，上鼓室保留术为5.7%，上鼓室开放术为80.8%（P<0.05）。（6）术后听力：根据问卷，上鼓室保留术的客观听力改善率为58.9%，上鼓室开放术为24.2%（P<0.05），而纯音听力测试显示听力阈值和气骨导差无显著差异。（7）术后满意度评分，上鼓室保留术为9.55分，上鼓室开放术为8.11分（P<0.05）。
（1）与上鼓室开放术相比，接受上鼓室保留术的患者外耳道形态接近正常，干耳时间短，生活质量高得多。（2）对于经验丰富的耳科医生，上鼓室保留术的适应证可扩展至板障型或硬化型乳突病例以及部分有解剖变异和颅内或颅外并发症的病例。
