Kamath M Panduranga, Sreedharan Suja, Rao A Raghavendra, Raj Vinay, Raju Krishnam
Department of ENT and Head & Neck Surgery, Kasturba Medical College, Manipal University, Mangalore, India.
Indian J Otolaryngol Head Neck Surg. 2013 Dec;65(4):358-62. doi: 10.1007/s12070-013-0651-9. Epub 2013 Apr 14.
The purpose of this study is to compare the efficacy of myringoplasty with or without cortical mastoidectomy in terms of freedom from discharge, graft take up and improvement in hearing. This is a Clinical prospective study of 120 patients from among a group of patients with chronic suppurative otitis media. A detailed history and examination was conducted including pure tone audiogram. Patients were randomly divided into two groups; group A would undergo myringoplasty only and group B would undergo cortical mastoidectomy with myringoplasty. Patients were reviewed after 3 weeks for inspection of the operated ear. Second post-operative review was at 3 months for clinicoaudiological assessment. Group B was found to have slightly more improvement as compared to the other group. No significant difference in the success rates of graft take-up in patients with unilateral or bilateral disease was found. Higher take up rates were seen in large (91.83 %) and medium perforations (90.69 %). In all our failed cases, post-operative ear discharge continued to be a persistent and troubling problem. The average audiological gain was 12.88 dB in group B, whereas it was 12.40 dB in group A. The reduction of air bone gap within each group was found to be significant. There is no statistical significant data indicating that tympanoplasty with mastoidectomy yields better results. When considering the addition of a mastoidectomy to a Tympanoplasty, the performing surgeon should consider not only the potential added benefit but also potential risks and costs to the patient.
本研究的目的是比较鼓膜成形术联合或不联合皮质乳突切除术在无耳漏、移植物吸收及听力改善方面的疗效。这是一项对120例慢性化脓性中耳炎患者进行的临床前瞻性研究。进行了详细的病史询问和检查,包括纯音听力图检查。患者被随机分为两组;A组仅接受鼓膜成形术,B组接受皮质乳突切除术联合鼓膜成形术。术后3周对手术耳进行检查。术后第二次复查在3个月时进行临床听力学评估。结果发现B组的改善程度略高于另一组。单侧或双侧疾病患者移植物吸收成功率无显著差异。大穿孔(91.83%)和中等穿孔(90.69%)的移植物吸收率较高。在所有失败病例中,术后耳漏仍是一个持续且棘手的问题。B组的平均听力学增益为12.88dB,而A组为12.40dB。发现每组内气骨导间距的缩小具有显著性。没有统计学显著数据表明乳突切除鼓室成形术能产生更好的结果。在考虑将乳突切除术添加到鼓室成形术中时,手术医生不仅应考虑潜在的额外益处,还应考虑对患者潜在的风险和成本。