Gao F Q, Wang L E, Gong S S, Wang Z X, Liang W Q
Department of Otolaryngology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018 Apr;32(7):530-533. doi: 10.13201/j.issn.1001-1781.2018.07.013.
To investigate the possible causes of non dry ear after canal wall down mastoidectomy(CWD).Clinical data of 42 patients undergoing revision CWD in our hospital were analyzed retrospectively,which included history,symptoms,signs,audiological examination,imaging examination, intraoperative findings and postoperative follow-up.All patients underwent CWD and tympanoplasty under general anesthesia.Twenty-six cases were insufficient opened of sinodural angle,36 cases remained mastoid air cell(9 cases is mastoid tip air cell remained),13 cases were inadequate exposured of anterior epitympanic recess, 23 cases were inadequate exposured of posterior tympanum, 25 cases had high facial ridge, posterior facial nerve and labyrinth air cell were 5 cases,3 cases had granulation in round window, 5 cases had dysfunctional eustachian tube, 32 cases had narrow external acoustic meatus. During 3 months,6 months and 1 year follow-up, all 42 cases patients under revision CWD presented with dry ears.Insufficient opened of sinodural angle and mastoid air cell,inadequate exposured of anterior epitympanic recess and posterior tympanum, high facial ridge, narrow external acoustic meatus are all the possible causes of no-dry ear after CWD; As the location of concealment, posterior facial nerve and labyrinth air cell are difficult to clean. The dressing cavity do not be cleaned in time after operation is also the underlying cause of postoperative non-dry ear.
探讨开放式乳突根治术(CWD)后不干耳的可能原因。回顾性分析我院42例行CWD翻修术患者的临床资料,包括病史、症状、体征、听力学检查、影像学检查、术中所见及术后随访情况。所有患者均在全身麻醉下行CWD及鼓室成形术。其中,26例岩上窦角开放不充分,36例残留乳突气房(9例残留乳突尖气房),13例上鼓室前隐窝暴露不充分,23例鼓室后部暴露不充分,25例面神经嵴较高,5例存在后半规管及迷路气房,3例圆窗有肉芽,5例咽鼓管功能不良,32例外耳道狭窄。在3个月、6个月及1年的随访中,42例行CWD翻修术的患者均实现干耳。岩上窦角及乳突气房开放不充分、上鼓室前隐窝及鼓室后部暴露不充分、面神经嵴较高、外耳道狭窄均为CWD术后不干耳的可能原因;后半规管及迷路气房位置隐蔽,难以清理干净。术后术腔未及时清理也是术后不干耳的潜在原因。