Keller Matthew, Sload Ryan, Wilson Justin, Greene Howard, Han Peggy, Wise Sean
1 Department of Otolaryngology-Head and Neck Surgery, Naval Hospital Camp Pendleton, Camp Pendleton, California, USA.
2 Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA.
Otolaryngol Head Neck Surg. 2017 Dec;157(6):1025-1033. doi: 10.1177/0194599817717486. Epub 2017 Jul 4.
Objectives To assess outcomes following tympanoplasty for blast-induced tympanic membrane perforations in a military population. Study Design Case series with chart review. Setting Tertiary care medical centers. Subjects and Methods Military personnel (N = 254) undergoing tympanoplasty for blast-related tympanic membrane perforations sustained between April 2005 and July 2014 were identified from the Expeditionary Medical Encounter Database. Descriptive statistics were obtained regarding demographics, primary and revision surgery success rates, hearing status pre- and postsurgery, and frequency of ossicular reconstruction. Rates of successful perforation closure were assessed against perforation size and character (central vs marginal) and time to surgery. Rates and types of complications were additionally explored. Results There were a total of 352 operations among 254 subjects, with an 82.1% rate of successful closure following primary surgery. For successful primary tympanoplasty, the mean improvement in pure tone average was 11.7 ± 12.1 dB. Ossiculoplasty was performed in 9.1% (32 of 352) of cases. There was no significant relationship between successful perforation closure and perforation size, perforation character, or time between injury and surgery. Cholesteatoma complicated 4.3% (15 of 352) of cases. A significant relationship was identified between risk of cholesteatoma development and increasing perforation size and marginal perforations. Conclusion Tympanoplasty success rates for blast-induced tympanic membrane perforations are lower than for other common injury mechanisms. Due to appreciable rates of postoperative cholesteatoma development, close clinical surveillance is recommended.
目的 评估军事人员中爆炸所致鼓膜穿孔行鼓室成形术后的结果。研究设计 带有病历回顾的病例系列。研究地点 三级医疗中心。对象与方法 从远征医疗遭遇数据库中识别出2005年4月至2014年7月期间因爆炸相关鼓膜穿孔而接受鼓室成形术的军事人员（N = 254）。获取了关于人口统计学、初次手术和翻修手术成功率、术前和术后听力状况以及听骨链重建频率的描述性统计数据。根据穿孔大小和特征（中央型与边缘型）以及手术时间评估穿孔成功闭合率。此外还探讨了并发症的发生率和类型。结果 254名受试者共进行了352例手术，初次手术后成功闭合率为82.1%。对于成功的初次鼓室成形术，纯音平均听阈的平均改善为11.7±12.1 dB。9.1%（352例中的32例）的病例进行了听骨成形术。穿孔成功闭合与穿孔大小、穿孔特征或受伤与手术之间的时间无显著关系。胆脂瘤并发4.3%（352例中的15例）的病例。胆脂瘤发生风险与穿孔大小增加和边缘性穿孔之间存在显著关系。结论 爆炸所致鼓膜穿孔的鼓室成形术成功率低于其他常见损伤机制。由于术后胆脂瘤发生率较高，建议进行密切的临床监测。
