Dispenza Francesco, Battaglia Alessia-Maria, Salvago Pietro, Martines Francesco
Department of Otorhinolaryngology, A.O.U.P. "Paolo Giaccone", Palermo, Italy.
Department of Bio.Ne.C, University of Palermo, Palermo, Italy.
Iran J Otorhinolaryngol. 2018 Nov;30(101):341-346.
The recurrence rate after tympanoplasty is variable between 0% and 50%. The causes of failure may be different and frequently interrelated, making the surgical choice difficult and the prognosis not always favourable. In this study, we analysed recurrence rate and the possible causes of failure of tympanoplasty in the treatment of tympanic perforations.
This prospective case-control study was carried out on patients undergoing tympanoplasty. The main outcome was closure of the tympanic membrane.
Among the studied 72 patients, the overall recurrence rate was 19.4%. The average follow-up was 28 months; no recurrence was observed over 12 months of follow-up. We observed a recurrence of 30.7% (OR 2.9) in near total perforations. In 32 subjects with a perforation of over half size of the membrane, a recurrence rate of 31.2% was noted (OR 4.09; P< 0.05). In 22 out of the 72 patients, there was a bilateral chronic otitis where the rate of recurrence was 27.2% (OR 1.9). During the postoperative period, 10 patients contracted infection of the middle/external ear, and in all of these cases failure of the surgical intervention was recorded (P<0.01).
The rate of recurrence is closely related to several factors that may be concomitant and therefore, worsen the prognosis. Perforations that affect more than 50% of the tympanic surface are related to a higher rate of failure and are often associated with one of the two conditions previously described. Postoperative infection is the most significant risk factor for recurrence.
鼓室成形术后的复发率在0%至50%之间变化。失败的原因可能不同且常常相互关联，这使得手术选择困难且预后并非总是良好。在本研究中，我们分析了鼓室成形术治疗鼓膜穿孔的复发率及可能的失败原因。
本前瞻性病例对照研究针对接受鼓室成形术的患者进行。主要观察指标为鼓膜闭合情况。
在研究的72例患者中，总体复发率为19.4%。平均随访时间为28个月；随访12个月内未观察到复发。我们观察到近全穿孔的复发率为30.7%（比值比2.9）。在32例穿孔面积超过鼓膜一半大小的患者中，复发率为31.2%（比值比4.09；P<0.05）。72例患者中有22例患有双侧慢性中耳炎，其复发率为27.2%（比值比1.9）。术后，10例患者发生中耳/外耳道感染，所有这些病例均记录手术干预失败（P<0.01）。
复发率与几个可能同时存在的因素密切相关，因此会使预后恶化。影响鼓膜表面超过50%的穿孔与更高的失败率相关，且常与上述两种情况之一相关。术后感染是复发的最显著危险因素。
