Bellucci R J
Department of Otolaryngology, New York Medical College.
Otolaryngol Clin North Am. 1989 Oct;22(5):911-26.
Meticulous mastoid surgery does not always result in a dry, stable ear. Eustachian tube malfunction has been accepted as an important factor in chronic and recurrent middle ear infection. There are many parameters of eustachian tube malfunction, which form a complicated problem for investigation and analysis. Of most importance appears to be varying degrees of malformation of the nasopharynx and palate. A gradient from mild to overt deformity appears to be related to the degree of eustachian tube function. Other factors, such as nasal infection and allergy, nasopharyngeal scar tissue and tumors, and general resistance to infection, are of less importance but must be considered in the etiology of chronic ear disease. Tympanoplasty is relatively unsuccessful in a chronic discharging ear, as the infection ultimately destroys a surgical repair. Persistent otorrhea can be caused by either eustachian tube malfunction or a reservoir of chronic infection in the mastoid cavity. A mastoidectomy often controls the infection in the mastoid cells and a tympanoplasty may be done as a secondary procedure when the cavity is stable. A careful preoperative evaluation should be made in every case to determine the responsible factors for persistent ear infection. If possible, attempts should be made to eliminate the causative factors prior to the tympanoplasty. Classification of cases into four groups helps to separate those cases with a good prognosis from those that will continue to suppurate and will have a poor functional result. A dual classification of tympanoplasty has been established in which the type of reconstruction is documented and the stability of the ear against infection is estimated. Classified clinical material forms the basis for a clearer representation of the cases under investigation and the results of tympanoplastic surgery become statistically comparable. Classification of cases also aids in the selection of cases for surgery by identifying preoperatively those cases that will be successful from those that may not have a good result. With this information at hand it is possible to more accurately inform the patient preoperatively regarding hearing improvement and control of infection following a tympanoplasty.
精细的乳突手术并不总能使耳朵保持干燥、稳定。咽鼓管功能障碍已被公认为慢性和复发性中耳感染的一个重要因素。咽鼓管功能障碍有许多参数，这构成了一个复杂的调查和分析问题。最重要的似乎是鼻咽和腭部不同程度的畸形。从轻度到明显畸形的梯度似乎与咽鼓管功能的程度有关。其他因素，如鼻腔感染和过敏、鼻咽瘢痕组织和肿瘤以及全身抗感染能力，虽然重要性稍低，但在慢性耳部疾病的病因学中也必须加以考虑。在慢性流脓耳中，鼓室成形术相对不太成功，因为感染最终会破坏手术修复。持续性耳漏可能由咽鼓管功能障碍或乳突腔内的慢性感染病灶引起。乳突切除术通常可控制乳突小房内的感染，当术腔稳定时，可作为二期手术进行鼓室成形术。每种情况都应进行仔细的术前评估，以确定持续性耳部感染的相关因素。如果可能，应在鼓室成形术前尝试消除致病因素。将病例分为四组有助于将预后良好的病例与那些将继续化脓且功能结果较差的病例区分开来。已经建立了鼓室成形术的双重分类，其中记录了重建类型，并评估了耳朵抗感染的稳定性。分类的临床资料为更清晰地呈现所研究的病例奠定了基础，鼓室成形手术的结果在统计学上也具有可比性。病例分类还有助于通过术前识别哪些病例可能成功、哪些病例可能效果不佳来选择手术病例。掌握这些信息后，就可以在术前更准确地告知患者鼓室成形术后听力改善和感染控制的情况。
