Heo Kyung Wook
Department of Otorhinolaryngology-Head & Neck Surgery, Inje University College of Medicine, Busan Paik Hospital, Busan, Republic of Korea.
Auris Nasus Larynx. 2017 Oct;44(5):517-521. doi: 10.1016/j.anl.2016.10.013. Epub 2016 Dec 8.
Although fascia is widely used as the grafting material in tympanoplasty (TP), unsatisfactory outcomes can result in patients with poor prognostic factors. Recently, cartilage has emerged as a graft material in TP. This study examined the operative outcomes of type I TP using a cartilage shield graft (CSG) in patients with poor prognostic factors.
This study reviewed the medical records of patients who underwent type I TP using CSG performed by the same surgeon, with over 24 months of follow-up.
There were 94 patients (mean age 46 years). Preoperatively, 39 patients had near-total perforation, 29 had a previous TP or myringoplasty, 14 had adhesive otitis media, and 12 had a marginal perforation covering ≥50% of the tympanic membrane area. The mean postoperative air-bone gap was significantly (p<0.0001) reduced compared to preoperative measurements. Postoperatively, tympanic membrane perforation occurred in 2.1% and otorrhea in 6.4%. There were no cases of retraction, adhesion, or lateralization. One subject complained of autophonia and ear fullness.
Type I TP using CSG has excellent surgical results and minimal complications, even in patients with poor prognostic factors, and should thus be considered in those patients.
尽管筋膜在鼓室成形术（TP）中被广泛用作移植材料，但对于具有不良预后因素的患者，可能会出现不理想的结果。最近，软骨已成为TP中的一种移植材料。本研究探讨了在具有不良预后因素的患者中使用软骨盾形移植片（CSG）进行I型TP的手术效果。
本研究回顾了由同一位外科医生进行CSG的I型TP患者的病历，并进行了超过24个月的随访。
共有94例患者（平均年龄46岁）。术前，39例患者有近全穿孔，29例曾接受过TP或鼓膜成形术，14例有粘连性中耳炎，12例有边缘穿孔，覆盖鼓膜面积≥50%。与术前测量相比，术后平均气骨导差显著降低（p<0.0001）。术后，鼓膜穿孔发生率为2.1%，耳漏发生率为6.4%。没有出现内陷、粘连或外移的病例。有1名受试者主诉耳内自听增强和耳闷。
即使对于具有不良预后因素的患者，使用CSG进行I型TP也具有出色的手术效果和极少的并发症，因此这些患者应考虑采用该方法。
