Han Y, Chen J, Yue B, Chen Y, Zha D J, Qiu J H
Department of Otolaryngology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Aug 20;31(16):1251-1253. doi: 10.13201/j.issn.1001-1781.2017.16.08.
To analyze the clinical effect of 54 cases with chronic otitis media prepared for staging tympanoplasty and 19 cases finished staging ossicular reconstruction surgery, evaluate the advantages of different surgery technique.Fifty-four cases with chronic otitis media were planned for staging tympanoplasty surgery and had been received the first stage surgery. Silicagel plates were placed in the tympanic cavity in order to prevent adhesions. Among them, 19 cases had received the second stage ossicular reconstruction, including 10 cases with TORPs and 9 cases with PORPs. The average air bone gaps (ABG) were measured at four frequencies: 500, 1 000, 2 000 and 4 000 Hz.Among the 54 cases, 45 cases had swollen mucosa in the tympanic cavity and eustachian tube, 18 cases had tympanic fibrous adhesions, and 12 cases had fixed or sclerotic stapes. The preoperative ABG of the 54 cases were (38.26±7.88)dB. As for the 19 cases finished the second stage surgery, their preoperative ABG in the first stage were (39.21±7.05)dB, the preoperative ABG in the second stage were (38.82±11.43)dB, and the postoperative ABG after the second stage were (21.77±11.92)dB. The hearing function after staging tympanoplasty was significantly improved compared with the preoperative hearing in the first and the second stage operation (< 0.01). In addition, the second stage surgery of three cases was postponed because of a good postoperative hearing with (10.42±10.63)dB ABG after the first stage surgery. Up to now, none of the 54 cases suffered from facial palsy, infection and other complications after surgery.Staging tympanoplasty is an important technique to improving hearing and reducing the complications, especially for the cases with chronic otitis media unsuitable for one stage reconstruction of ossicular chain.
分析54例准备行分期鼓室成形术的慢性中耳炎患者及19例完成分期听骨链重建手术患者的临床效果,评估不同手术技术的优势。54例慢性中耳炎患者计划行分期鼓室成形术并已接受第一期手术。在鼓室内放置硅胶板以防止粘连。其中19例接受了第二期听骨链重建,包括10例全听骨赝复物(TORP)和9例部分听骨赝复物(PORP)。在500、1000、2000和4000Hz四个频率测量平均气骨导差(ABG)。54例患者中,45例鼓室及咽鼓管黏膜肿胀,18例鼓膜纤维粘连,12例镫骨固定或硬化。54例患者术前ABG为(38.26±7.88)dB。对于完成第二期手术的19例患者,其第一期术前ABG为(39.21±7.05)dB,第二期术前ABG为(38.82±11.43)dB,第二期术后ABG为(21.77±11.92)dB。分期鼓室成形术后听力功能与第一期和第二期手术术前听力相比有显著改善(<0.01)。此外,3例患者因第一期手术后ABG为(10.42±10.63)dB且术后听力良好而推迟了第二期手术。截至目前,54例患者术后均未出现面瘫、感染等并发症。分期鼓室成形术是提高听力和减少并发症的重要技术,尤其适用于不适于一期听骨链重建的慢性中耳炎患者。