Luers Jan Christoffer, Hüttenbrink Karl-Bernd
Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany.
J Anat. 2016 Feb;228(2):338-53. doi: 10.1111/joa.12389. Epub 2015 Oct 19.
Middle ear surgery is strongly influenced by anatomical and functional characteristics of the middle ear. The complex anatomy means a challenge for the otosurgeon who moves between preservation or improvement of highly important functions (hearing, balance, facial motion) and eradication of diseases. Of these, perforations of the tympanic membrane, chronic otitis media, tympanosclerosis and cholesteatoma are encountered most often in clinical practice. Modern techniques for reconstruction of the ossicular chain aim for best possible hearing improvement using delicate alloplastic titanium prostheses, but a number of prosthesis-unrelated factors work against this intent. Surgery is always individualized to the case and there is no one-fits-all strategy. Above all, both middle ear diseases and surgery can be associated with a number of complications; the most important ones being hearing deterioration or deafness, dizziness, facial palsy and life-threatening intracranial complications. To minimize risks, a solid knowledge of and respect for neurootologic structures is essential for an otosurgeon who must train him- or herself intensively on temporal bones before performing surgery on a patient.
中耳手术受到中耳解剖和功能特征的强烈影响。复杂的解剖结构对耳外科医生来说是一项挑战，他们需要在保留或改善高度重要的功能（听力、平衡、面部运动）与根除疾病之间权衡。其中，鼓膜穿孔、慢性中耳炎、鼓室硬化症和胆脂瘤在临床实践中最为常见。现代听骨链重建技术旨在使用精致的异体钛假体尽可能改善听力，但许多与假体无关的因素阻碍了这一目标的实现。手术总是根据具体情况个体化进行，不存在适用于所有情况的策略。最重要的是，中耳疾病和手术都可能伴有多种并发症；其中最重要的是听力下降或耳聋、头晕、面瘫以及危及生命的颅内并发症。为了将风险降至最低，耳外科医生必须对神经耳科结构有扎实的了解并予以尊重，在对患者进行手术之前，必须在颞骨上进行强化训练。
