局部用雌激素对慢性鼓膜穿孔愈合及听力阈值的影响。
The effect of topical estrogen on healing of chronic tympanic membrane perforations and hearing threshold.
作者信息
Barati Behrouz, Abtahi Seyyed Hamid Reza, Hashemi Seyyed Mostafa, Okhovat Seyyed Ahmad Reza, Poorqasemian Mehdi, Tabrizi Ali Goljanian
机构信息
Department of Otorhinolaryngology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
出版信息
J Res Med Sci. 2013 Feb;18(2):99-102.
BACKGROUND
Considering the presence of squamous epithelial cells and fibroblasts in the tympanic membrane (TM), topical estrogen application may influence the repair of TM perforations. Therefore, this study was designed to investigate the healing effect of topical estrogen on chronic TM perforations and improvement in hearing threshold.
MATERIALS AND METHODS
Sixty patients were enrolled in a randomized clinical trial. Thirty patients were treated with paper patch and 30 with estrogen-impinged paper patch. Complete closure of the TM perforation and hearing threshold were evaluated in both groups. Chronic unilateral perforations of the TM involving less than 40% of the total area of the TM without active disease in the middle ear were selected. The margin of the perforation was chemically trimmed using 15% trichloroacetic acid and patching performed under an operating microscope. Microscopic examination was performed after 14 days and repeated after 30 days. Complete closure of the TM perforation was considered as successful repair. Hearing threshold was determined before the start of the trial and 30 days after treatment.
RESULTS
No significant difference was found between the two groups after 14 days in complete closure of the perforation (P = 0.310). After 30 days, patients treated with estrogen-impinged paper patch showed a significantly higher rate of closure of the perforation (63.4%) and improvement in hearing threshold (P = 0.017).
CONCLUSION
Topical estrogen may have a healing effect on chronic TM perforations and improvement in hearing threshold.
背景
鉴于鼓膜（TM）中存在鳞状上皮细胞和成纤维细胞，局部应用雌激素可能会影响鼓膜穿孔的修复。因此，本研究旨在探讨局部应用雌激素对慢性鼓膜穿孔的愈合效果及听力阈值的改善情况。
材料与方法
60例患者纳入一项随机临床试验。30例患者接受纸片修补治疗，30例接受雌激素浸渍纸片修补治疗。评估两组鼓膜穿孔的完全闭合情况及听力阈值。选择慢性单侧鼓膜穿孔，穿孔面积小于鼓膜总面积的40%，且中耳无活动性疾病。用15%三氯乙酸对穿孔边缘进行化学修整，并在手术显微镜下进行修补。术后14天进行显微镜检查，30天后重复检查。鼓膜穿孔完全闭合视为修复成功。在试验开始前及治疗后30天测定听力阈值。
结果
14天后，两组在穿孔完全闭合方面无显著差异（P = 0.310）。30天后，接受雌激素浸渍纸片修补治疗的患者穿孔闭合率（63.4%）及听力阈值改善情况显著更高（P = 0.017）。
结论
局部应用雌激素可能对慢性鼓膜穿孔有愈合作用，并能改善听力阈值。
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