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慢性静止性中耳黏膜炎症的手术治疗结果

Outcome of Surgery in Chronic Inactive Mucosal Otitis Media.

作者信息

Islam M A, Haque S, Ahmed K, Bari M S, Hoque M M, Khan M K, Haque N, Haque N, Reza-Ul-Haq K M, Kobir M S

机构信息

Dr Md Amirul Islam, Associate Professor (CC), Department of ENT&HNS, Dhaka Community Medical College & Hospital, Dhaka, Bangladesh.

出版信息

Mymensingh Med J. 2018 Jul;27(3):617-625.

PMID:30141454
Abstract

Chronic otitis media is a common condition seen in patients attending the otorhinolaryngology Department. The discharging ear presents the otologists with the dilemma of operating on it or not. The aim of the this cross-sectional observational study was to find out the outcome of surgery in chronic inactive mucosal otitis media and was conducted on 62 patients of either sex in the age group of 15-60 years in the Department of ENT and Head Neck surgery, Shaheed Suhrawardy Medical College Hospital (ShSMCH), Dhaka, Bangladesh From July 2015 to January 2016. Pre and post operative hearing assessment was done with pure tone audiometry (PTA). Post operative graft status also noted. All the information's were recorded in the fixed protocol. Collected data were classified, edited, coded and entered into the computer for statistical analysis by using updated computerized program SPSS-19. Among 62 cases the mean age were 36.79±10.33 in chronic inactive mucosal otitis media. Majority of the study population were in age group of between 15-25 in this group of which was 16(51.6%). Male were 36(58.06) and 26(41.94) were female. All patients presented with history of otorrhoea in this group, 52(83.87%) had hearing impairment in chronic inactive mucosal otitis media, 30(48.39%) involved in right ear and 26(41.94%) involved in left ear and 06(9.68%) in both ear in chronic inactive mucosal otitis media. Majority of perforation were medium in size in this group of which was 30(48.39%). anterior perforation was 24(38.71%), posterior perforation 28(45.16%) and subtotal 10(16.13%) in chronic inactive mucosal otitis media. Sixty two (100%) cases underwent myringoplasty. Post-auricular approach used in most of operation in this group of which was 60(96.77%). Preoperative air conduction threshold 32(51.61%) were in between 31-45 dB in myringoplasty group (p<0.05) that was statistically significant. Postoperative air conduction threshold 30(48.39%) were between 16-30 dB in myringoplasty group (p<0.05) that was statistically significant. Difference between preoperative and postoperative air conduction threshold mean difference was 11.38 dB and 36.75±5.84 and 25.37±7.46 respectively (p<0.001) in myringoplasty group. Hearing gain was 42(67.74%) in myringoplasty (p>0.05) that was not statistically significant. Graft uptake in myringoplasty was 52(83.9%). Graft failure in myringoplasty was 10(16.1%). post operative complication was tinnitus in 12(19.35%) cases in myringoplasty. Success rate was more in case of posterior perforation than anterior and subtotal perforation in both chronic inactive mucosal otitis media which was 92.86%. Success rate was more in case of medium size perforation than subtotal perforation in chronic inactive mucosal otitis media which was 86.67%. Success rate was (100%) in small perforation in this group. From this study it can be concluded that myringoplasty is a valid treatment modality for chronic inactive mucosal otitis media to achieve an intact tympanic membrane and to gain hearing.

摘要

慢性中耳炎是耳鼻喉科门诊患者的常见病症。耳部流脓使耳科医生面临是否进行手术的两难境地。本横断面观察性研究的目的是了解慢性静止性黏膜中耳炎的手术效果,于2015年7月至2016年1月在孟加拉国达卡的谢赫·苏赫拉瓦迪医学院医院(ShSMCH)耳鼻喉头颈外科对62例年龄在15 - 60岁的男女患者进行了研究。术前和术后采用纯音听力计(PTA)进行听力评估。同时记录术后移植物状态。所有信息均按照固定方案记录。收集的数据进行分类、编辑、编码,并使用更新的计算机程序SPSS - 19录入计算机进行统计分析。在62例慢性静止性黏膜中耳炎病例中,平均年龄为36.79±10.33岁。该组研究人群大多数年龄在15 - 25岁之间,为16例(51.6%)。男性36例(58.06%),女性26例(41.94%)。该组所有患者均有耳漏病史,52例(83.87%)在慢性静止性黏膜中耳炎中有听力障碍,30例(48.39%)累及右耳,26例(41.94%)累及左耳,6例(9.68%)双耳受累。该组大多数穿孔为中等大小,为30例(48.39%)。慢性静止性黏膜中耳炎中,前穿孔24例(38.71%),后穿孔28例(45.16%),次全穿孔10例(16.13%)。62例(100%)病例接受了鼓膜成形术。该组大多数手术采用耳后入路,为60例(96.77%)。鼓膜成形术组术前气导阈值32例(51.61%)在31 - 45 dB之间(p<0.05),具有统计学意义。鼓膜成形术组术后气导阈值30例(48.39%)在16 - 30 dB之间(p<0.05),具有统计学意义。鼓膜成形术组术前和气导阈值平均差异分别为11.38 dB,术前为36.75±5.84,术后为25.37±7.46(p<0.001)。鼓膜成形术听力改善42例(67.74%)(p>0.05),无统计学意义。鼓膜成形术中移植物摄取率为52例(83.9%)。鼓膜成形术中移植物失败10例(16.1%)。鼓膜成形术术后12例(19.35%)出现耳鸣并发症。在慢性静止性黏膜中耳炎中,后穿孔的成功率高于前穿孔和次全穿孔,为92.86%。在慢性静止性黏膜中耳炎中,中等大小穿孔的成功率高于次全穿孔,为86.67%。该组小穿孔的成功率为(100%)。从本研究可以得出结论,鼓膜成形术是治疗慢性静止性黏膜中耳炎以实现鼓膜完整和提高听力的有效治疗方式。

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