Babu Seilesh, Luryi Alexander L, Schutt Christopher A
Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Novi, Michigan.
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
Laryngoscope. 2019 May;129(5):1206-1210. doi: 10.1002/lary.27599. Epub 2018 Nov 21.
OBJECTIVES/HYPOTHESIS: A hybrid variation of a tympanoplasty technique, termed over-under tympanoplasty (OUT), was evaluated to demonstrate the long-term outcomes and complications compared to medial tympanoplasty.
Retrospective review.
Patients who underwent a tympanoplasty between 2010 and 2015 were included. Primary outcome measures included graft healing at 18 months, change in air-bone gap (ABG), and change in high-frequency hearing at 8 kHz. The Shapiro-Wilk test, Student t test, and nonparametric Mann-Whitney test were used to compare results. Univariate logistic regression analysis was used to identify potential predictors of surgical success.
One hundred eleven patients were included; 84 underwent the over-under technique and 27 underwent medial tympanoplasty. At the 18-month follow-up, 100% of patients in the medial tympanoplasty group had closure of the TM perforation compared to 84% (71/84) in the over-under group. In the over-under group, 12% of patients developed small or pinpoint perforations, and 4% developed larger, recurrent perforations. Mean improvement in ABG was similar between the two groups (11.6 dB for the medial group vs. 11.9 dB for the over-under group, P < .001). No hearing loss was noted in either group. No lateralization of the graft or anterior blunting was noted.
In this series, the OUT technique had a high success rate with TM perforations, including anterior, near total, and total perforations. Hearing loss from dissection on the malleus was not found. This approach blends the advantages and minimizes the disadvantages of the classic techniques and is well suited for all types of tympanic membrane perforations.
3b Laryngoscope, 129:1206-1210, 2019.
目的/假设：评估一种鼓室成形术技术的混合变体，即上下鼓室成形术（OUT），以证明其与内侧鼓室成形术相比的长期疗效和并发症。
回顾性研究。
纳入2010年至2015年间接受鼓室成形术的患者。主要结局指标包括18个月时移植物愈合情况、气骨导间距（ABG）变化以及8kHz时高频听力变化。采用夏皮罗-威尔克检验、学生t检验和非参数曼-惠特尼检验比较结果。单因素逻辑回归分析用于确定手术成功的潜在预测因素。
共纳入111例患者；84例行上下鼓室成形术，27例行内侧鼓室成形术。在18个月的随访中，内侧鼓室成形术组100%的患者鼓膜穿孔闭合，而上下鼓室成形术组为84%（71/84）。在上下鼓室成形术组中，12%的患者出现小穿孔或针尖样穿孔，4%的患者出现较大的复发性穿孔。两组ABG的平均改善情况相似（内侧组为11.6dB，上下鼓室成形术组为11.9dB，P＜0.001）。两组均未出现听力损失。未发现移植物侧化或前部钝圆。
在本系列研究中，OUT技术治疗鼓膜穿孔（包括前部、近全层和全层穿孔）成功率较高。未发现因锤骨解剖导致的听力损失。该方法融合了经典技术的优点，将缺点降至最低，适用于所有类型的鼓膜穿孔。
3b《喉镜》，2019年，第129卷，第1206 - 1210页
