Zwierz Aleksander, Haber Karolina, Sinkiewicz Anna, Kalińczak-Górna Paulina, Tyra Justyna, Mierzwiński Józef
Department of Otolaryngology, Audiology and Phoniatrics, Children's Hospital of Bydgoszcz, Bydgoszcz, Poland.
Department of Otolaryngology, Audiology and Phoniatrics, University Hospital of Bydgoszcz, Bydgoszcz, Poland.
Eur Arch Otorhinolaryngol. 2019 Feb;276(2):323-333. doi: 10.1007/s00405-018-5193-z. Epub 2018 Nov 27.
The aim of this study was to determine the importance of selected prognostic factors on outcomes of tympanoplasty in children.
241 children classified into three age groups (3-7, 8-12 and 13-18), had undergone tympanoplasty between 2001 and 2007 and were subsequently observed for at least 2 years. Prognostic factors were assessed with regard to their impact on the functional and anatomical outcome of the tympanoplasty defined, respectively, as postoperative air-bone gap and state of the middle ear.
In 85% of children, a tympanic membrane reconstruction was performed. An unchanged TM was achieved in 85% of the patients in early results and in 76% in later results. Air-bone gap closure was observed in 66% of cases. The earlier preventive retraction pocket tympanoplasty was performed, the better anatomical results were obtained-ranging from 91% in the 3-7 age group versus 75-70% in 8-12 and 13-18 age groups. The results of total or subtotal perforation reconstructions were worse than for small perforation with closure rates of 76.5% vs 94.5%, respectively.
Age is not a factor determining the success rate in pediatric tympanoplasty. A better surgical outcome can be achieved in children with a dry ear, and better middle ear condition, because of previously performed surgeries. Preventive tympanoplasty is also advantageous. The hearing results in type 2 and 3 tympanoplasty are similar, but type 1 tympanoplasty has superior efficacy to the former two types.
本研究旨在确定所选预后因素对儿童鼓室成形术预后的重要性。
241名儿童被分为三个年龄组（3 - 7岁、8 - 12岁和13 - 18岁），于2001年至2007年间接受了鼓室成形术，随后至少观察了2年。评估了预后因素对鼓室成形术功能和解剖学预后的影响，分别将其定义为术后气骨导间距和中耳状况。
85%的儿童进行了鼓膜重建。早期结果中85%的患者鼓膜保持不变，后期结果中这一比例为76%。66%的病例观察到气骨导间距缩小。预防性内陷袋鼓室成形术实施得越早，解剖学结果越好——3 - 7岁年龄组为91%，而8 - 12岁和13 - 18岁年龄组为75% - 70%。全层或大部分穿孔重建的结果比小穿孔更差，闭合率分别为76.5%和94.5%。
年龄不是决定儿童鼓室成形术成功率的因素。对于耳干、中耳状况较好且因先前手术的儿童，可获得更好的手术效果。预防性鼓室成形术也具有优势。2型和3型鼓室成形术的听力结果相似，但1型鼓室成形术的疗效优于前两种类型。
