Kouhi Ali, Khorsandi Ashthiani Mohammad Taghi, Jalali Mir Mohammad
Rhino-Sinus, Ear, and Skull Base Diseases Research Center,Guilan University of Medical Sciences, Rasht, Iran.
Iran J Otorhinolaryngol. 2018 Mar;30(97):103-106.
There remains controversy about the optimal kind of graft to repair tympanic membrane. The purpose of this study was to evaluate the anatomical and auditory outcomes of type I tympanoplasty using fascia with or without cartilage reinforcement.
This retrospective cohort study was conducted from 2005 to 2015. All cases were surgically treated by a single surgeon. We excluded cases in which the etiology of chronic otitis media was cholesteatoma. According to the use of cartilage reinforcement in the posterosuperior part of the graft, patients were divided into two groups, and the results of anatomical and auditory evaluation were compared between the two groups. The anatomical outcome was grafting success and the auditory outcome was improvement of air bone gap (ABG).
A total of 320 patients were classified in Group A (tympanoplasty with fascia temporalis only) and 346 were in Group B (tympanoplasty with cartilage reinforcement). All patients were followed for at least 2 years. The overall success rate in the two groups was 91.6% and 93.4%, respectively (P=0.3). The most common cause of failure in the two groups was re-perforation (5.6% and 3.8%, respectively). The improvement of ABG in two groups was 18.5 dB and 3.2 dB, respectively. The difference between two groups was statistically significant (P<0.001).
In patients with dry perforation of the tympanic membrane, the anatomical success with tympanoplasty with fascia only or with cartilage reinforcement was similar. However, hearing improvement in the fascia only group was greater than in the group undergoing cartilage reinforcement.
关于修复鼓膜的最佳移植物类型仍存在争议。本研究的目的是评估使用或不使用软骨加固的筋膜进行I型鼓室成形术的解剖学和听觉效果。
本回顾性队列研究于2005年至2015年进行。所有病例均由一名外科医生进行手术治疗。我们排除了慢性中耳炎病因是胆脂瘤的病例。根据移植物后上部是否使用软骨加固，将患者分为两组，并比较两组的解剖学和听觉评估结果。解剖学结果是移植成功，听觉结果是气骨导差（ABG）改善。
共有320例患者被归入A组（仅使用颞肌筋膜进行鼓室成形术），346例患者被归入B组（使用软骨加固进行鼓室成形术）。所有患者均随访至少2年。两组的总体成功率分别为91.6%和93.4%（P = 0.3）。两组最常见的失败原因是再次穿孔（分别为5.6%和3.8%）。两组ABG的改善分别为18.5 dB和3.2 dB。两组之间的差异具有统计学意义（P < 0.001）。
在鼓膜干性穿孔患者中，仅使用筋膜或使用软骨加固进行鼓室成形术的解剖学成功率相似。然而，仅使用筋膜组的听力改善大于接受软骨加固组。
