Li H L, Zhang Z F, Wang W Q
Department of Otolaryngology Head and Neck Surgery,the Second People's Hospital of Kashi,Kashi,844000,China.
Department of Otolaryngology Head and Neck Surgery,EENT Hospital of Fudan University.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Oct 5;31(19):1473-1477. doi: 10.13201/j.issn.1001-1781.2017.19.003.
Through analysis of the tympanic membrane perforation rate and hearing improvement rate with chronic suppurative otitis media (CSOM) by myringoplasty,to observe the effect of different preoperative conditions such as middle ear lesion,eustachian tube (ET) function and infection status on the postoperative curative effect.Retrospective analysis of EENT Hospital of Fudan University from January 2012 to November 2016 during the 203 cases (203 ears) with clinical data of myringoplasty: according to intraoperative exploration of the presence of purulent secretions in the tympanic cavity,divided into infection active group and infection quiescence group; according to the preoperative results of the function of ET with acoustic impedance test divided into dysfunction or good group; according to the preoperative temporal bone HRCT suggested that the middle ear (mastoid cells,tympanic antrum and tympanic cavity) with or without soft tissue density,divided into the group with no focal lesion and the group with focal lesion. Review endoscopy and pure tone audiometry after 3 to 6 months. Using SPSS 19.0 statistical software to compare the differences among them of tympanic membrane perforation rate and hearing improvement rate.Single factor analysis: ①The infection quiescence group of tympanic membrane perforation rate was 11.93%(13/109),higher than the infection active group ［8.51%(8/94)］; the infection quiescence group of hearing improvement rate was 75.23%(82/109),below the infection active group ［79.79%(75/94)］,no statistically significant differences of them (>0.05).②The group with dysfunction of ET of tympanic membrane perforation rate was 14.06%(9/64),significantly higher than the group［4.04%(4/99)］with good function ET,with statistical difference of them (<0.05); the group with dysfunction of ET of hearing improvement rate was 76.56% (49/64),lower than the group［81.82%(81/99)］with good function of ET,no significant difference of them (>0.05).③The group with no obvious lesion of tympanic membrane perforation rate was 9.09% (10/110),lower than the group ［11.83%(11/93)］with focal lesion; the group with no obvious lesion of hearing improvement rate was 78.18% (86/110),higher than the group with focal lesion ［76.34%(71/93)］,no significant difference of them (>0.05).Multivariate analysis: ①There was a significant correlation of postop-erative tympanic membrane perforation rate with preoperative ET functi-on (<0.05).There was no significant correlation of the postoperative tympanic membrane perforation rate with the infection status and the temporal bone HRCT images in the middle ear lesions (>0.05).②There was no significant correlation of the postoperative hearing improvement rate with the infection status,the ET function and the temporal bone HRCT images in the middle ear lesions (>0.05).Dysfunction of ET and localized lesions of the ear were more common in infection active;the accumulation of purulent exudate on the surface of the tympanic mucosa and localized lesions of the middle ear did not affect the healing rate of the tympanic membrane and the hearing improvement rate; ET function is one of the most important factors that affect the healing rate of tympanic membrane after operation,the patients with ET dysfunction are more likely to affect tympanic membrane perforation,but does not affect the hearing improvement rate.
通过分析鼓膜成形术治疗慢性化脓性中耳炎（CSOM）的鼓膜穿孔率及听力改善率，观察中耳病变、咽鼓管（ET）功能及感染状态等不同术前情况对术后疗效的影响。回顾性分析复旦大学附属眼耳鼻喉科医院2012年1月至2016年11月期间203例（203耳）鼓膜成形术的临床资料：根据术中探查鼓室有无脓性分泌物，分为感染活动组和感染静止组；根据术前声阻抗测试ET功能结果分为功能不良组或良好组；根据术前颞骨HRCT提示中耳（乳突气房、鼓窦及鼓室）有无软组织密度影，分为无局灶性病变组和有局灶性病变组。术后3至6个月复查耳内镜及纯音听力测试。采用SPSS 19.0统计软件比较各组间鼓膜穿孔率及听力改善率的差异。单因素分析：①感染静止组鼓膜穿孔率为11.93%（13/109），高于感染活动组［8.51%（8/94）］；感染静止组听力改善率为75.23%（82/109），低于感染活动组［79.79%（75/94）］，差异均无统计学意义（>0.05）。②ET功能不良组鼓膜穿孔率为14.06%（9/64），显著高于ET功能良好组［4.04%（4/99）］，差异有统计学意义（<0.05）；ET功能不良组听力改善率为76.56%（49/64），低于ET功能良好组［81.82%（81/99）］，差异无统计学意义（>0.05）。③无明显病变组鼓膜穿孔率为9.09%（10/110），低于有局灶性病变组［11.83%（11/93）］；无明显病变组听力改善率为78.18%（86/110），高于有局灶性病变组［76.34%（71/93）］，差异无统计学意义（>0.05）。多因素分析：①术后鼓膜穿孔率与术前ET功能显著相关（<0.05）。术后鼓膜穿孔率与感染状态及中耳病变的颞骨HRCT图像无显著相关性（>0.05）。②术后听力改善率与感染状态、ET功能及中耳病变的颞骨HRCT图像无显著相关性（>0.05）。感染活动组中ET功能不良及耳部局限性病变更为常见；鼓室黏膜表面脓性渗出物积聚及中耳局限性病变不影响鼓膜愈合率及听力改善率；ET功能是影响术后鼓膜愈合率的最重要因素之一，ET功能不良的患者更易发生鼓膜穿孔，但不影响听力改善率。
