在伴有黏膜缺损的慢性中耳炎的一期开放式鼓室成形术中进行钛质听骨链重建
Titanium ossicular chain reconstruction in single stage canal wall down tympanoplasty for chronic otitis media with mucosa defect.
作者信息
Gu Feng-Ming, Chi Fang-Lu
机构信息
Department of Otology and Skull Base Surgery, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China.
Department of Otology and Skull Base Surgery, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China.
出版信息
Am J Otolaryngol. 2019 Mar-Apr;40(2):205-208. doi: 10.1016/j.amjoto.2018.11.012. Epub 2018 Nov 28.
PURPOSE
To evaluate surgical outcomes for chronic otitis media with mucosa defect underwent titanium ossicular chain reconstruction (OCR) in single stage canal wall down tympanoplasty (CWD).
METHODS
A clinical retrospective study was performed on 83 cases of the chronic otitis media with mucosa defect and 123 ears with mucosa integrity according to intraoperative findings that underwent synchronous titanium OCR in single stage CWD form January 2012 to January 2018. Pre- and postoperative air conduction threshold (AC), air-bone gap (ABG) and ABG closure at 0.5, 1, 2, and 4 kHz were investigated.
RESULTS
The overall mean AC threshold of 53.4 ± 16.5 dB was lowered to 41.2 ± 15.9 dB postoperatively (p < 0.01). The mean pre- and postoperative ABG of all patients were 27.9 ± 9.9 dB and 17.2 ± 9.3 dB (p < 0.01), respectively, with a mean ABG closure of 10.7 ± 8.4 dB. The total rate of success, postoperative ABG ≤ 20 dB was achieved in 71.4%. In the mucosa defect group underwent TORP, the mean pre- and postoperative ABG were 28.1 ± 9.8 dB and 20.1 ± 9.0 dB (p < 0.01), respectively, with the ABG closure was 8.0 ± 7.9 dB. In the mucosa defect group underwent PORP, the mean pre- and postoperative ABG were 27.9 ± 10.1 dB and 16.5 ± 9.1 dB (p < 0.01), respectively, with the ABG closure was 11.4 ± 8.6 dB. Furthermore, in the mucosa defect group, there was significant difference in success rate of achieved postoperative ABG ≤ 20 dB between the TORP (48.9%) and PORP (77.5%) (p < 0.05).
CONCLUSION
It is revealed PORP in single stage CWD tympanoplasty for the patients suffered from chronic otitis media with mucosa defect is favored.
目的
评估在开放式鼓室成形术（CWD）一期手术中，对慢性中耳炎伴黏膜缺损患者行钛质听骨链重建（OCR）的手术效果。
方法
对2012年1月至2018年1月期间，83例慢性中耳炎伴黏膜缺损患者及123例黏膜完整患者，根据术中所见，在CWD一期手术中同步行钛质OCR进行临床回顾性研究。调查术前及术后0.5、1、2和4 kHz的气导阈值（AC）、气骨导间距（ABG）及ABG闭合情况。
结果
总体平均AC阈值从术前的53.4±16.5 dB降至术后的41.2±15.9 dB（p<0.01）。所有患者术前及术后平均ABG分别为27.9±9.9 dB和17.2±9.3 dB（p<0.01），平均ABG闭合为10.7±8.4 dB。术后ABG≤20 dB的总成功率为71.4%。在接受全听骨赝复物（TORP）的黏膜缺损组中，术前及术后平均ABG分别为28.1±9.8 dB和20.1±9.0 dB（p<0.01），ABG闭合为8.0±7.9 dB。在接受部分听骨赝复物（PORP）的黏膜缺损组中，术前及术后平均ABG分别为27.9±10.1 dB和16.5±9.1 dB（p<0.01），ABG闭合为11.4±8.6 dB。此外，在黏膜缺损组中，TORP（48.9%）和PORP（77.5%）术后ABG≤20 dB的成功率存在显著差异（p<0.05）。
结论
结果显示，对于慢性中耳炎伴黏膜缺损患者，在CWD一期鼓室成形术中采用PORP更具优势。
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