Wick Cameron C, Arnaoutakis Demetri, Kaul Vivian F, Isaacson Brandon
1 Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
2 Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, USA.
Otolaryngol Head Neck Surg. 2017 Oct;157(4):683-689. doi: 10.1177/0194599817709436. Epub 2017 Jun 6.
Objective To describe a novel technique for lateral graft tympanoplasty. Study Design Case series with chart review. Setting Tertiary care university hospital. Subjects and Methods Pediatric and adult patients with tympanic membrane perforations deemed unfavorable for a medial graft technique due to the perforation characteristics or myringitis. Results Between 2014 and 2016, 34 ears from 31 patients underwent a transcanal endoscopic lateral cartilage graft tympanoplasty. The mean age was 24.4 years (range, 6-71 years), and 22 patients (65%) were younger than 18 years. All patients had tympanic membrane perforations. Eighteen patients (53%) had total or near-total perforations, leaving a minimal anterior remnant, and 16 patients (47%) had extensive myringitis. A bisected tragal cartilage-perichondrium shield graft was used in 33 patients (97%). The mean (SD) follow-up length was 9.8 (5.7) months. Initial perforation closure rate was 88.2% (30/34). Three of the persistent perforations underwent a revision endoscopic medial graft tympanoplasty with successful closure, leaving a final closure rate of 97.1% (33/34). Five patients (15%) required topical therapy for postoperative myringitis. Mean (SD) pure-tone average and air-bone gap significantly improved by 11.5 (10.7) dB ( P < .001) and 11.4 (10.6) dB ( P < .001), respectively. Twenty-seven patients (79%) closed their air-bone gap within 20 dB. Conclusion Transcanal endoscopic lateral cartilage graft tympanoplasty is feasible, and initial data support favorable outcomes. Further data are necessary for evaluation of long-term results and efficacy comparisons.
目的 描述一种新型的外侧移植鼓室成形术技术。研究设计 带有病历回顾的病例系列研究。研究地点 三级医疗大学医院。研究对象和方法 因穿孔特征或鼓膜炎而被认为不适合采用内侧移植技术的鼓膜穿孔的儿科和成年患者。结果 在2014年至2016年期间，31例患者的34耳接受了经耳道内镜下外侧软骨移植鼓室成形术。平均年龄为24.4岁（范围6至71岁），22例患者（65%）年龄小于18岁。所有患者均有鼓膜穿孔。18例患者（53%）有全层或近全层穿孔，仅留最小的前部残余，16例患者（47%）有广泛的鼓膜炎。33例患者（97%）使用了对半切开的耳屏软骨-软骨膜盾牌移植物。平均（标准差）随访时间为9.8（5.7）个月。初始穿孔闭合率为88.2%（30/34）。3例持续性穿孔患者接受了改良内镜下内侧移植鼓室成形术并成功闭合，最终闭合率为97.1%（33/34）。5例患者（15%）术后鼓膜炎需要局部治疗。平均（标准差）纯音平均听阈和气骨导差分别显著改善11.5（10.7）dB（P <.001）和11.4（10.6）dB（P <.001）。27例患者（79%）气骨导差缩小至20 dB以内。结论 经耳道内镜下外侧软骨移植鼓室成形术是可行的，初步数据支持良好的结果。需要进一步的数据来评估长期结果和进行疗效比较。
