Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal.
Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal.
Acta Otorrinolaringol Esp (Engl Ed). 2021 May-Jun;72(3):182-189. doi: 10.1016/j.otorri.2020.04.009. Epub 2020 Aug 27.
To evaluate success rate of type I tympanoplasty in adults and to investigate the importance of selected prognostic factors on graft uptake.
Retrospective medical chart review of 155 patients who underwent Type I Tympanoplasty, in our department, from January 2013 to December 2017. Graft uptake rate was evaluated and the effects of prognostic factors on surgical outcome such as sex, smoking and otological surgery history, status of the contralateral ear, size and location of the perforation, middle ear mucosa status, surgical approach and graft material. Preoperative and postoperative audiometric data were collected, and the functional success was determined.
The overall surgical anatomical success rate was 75%. Analysis of the selected variables, identified as independent prognostic factors of anatomical unsuccess (95% CI): smoking (OR=3.29, p<.01), middle ear tympanosclerosis (OR=2.96; p=.04). Perforations above 50% of the tympanic membrane area had a borderline effect on graft uptake (p=.05). There was a significative improvement in the average air conduction thresholds of 7.44dB and an ABG closure rate at 10dB and 20dB was achieved in 47% and 84.5%, respectively. Patients who received temporalis fascia graft had similar hearing gain compared to patients who underwent cartilage tympanoplasty (7.7 vs. 7.3dB, p=.79).
Type I tympanoplasty is an effective and safe procedure with a high anatomical success rate in the treatment of mucosal COM. Poorer outcomes were found in patients with smoking habits, in those with tympanosclerosis of middle ear mucosa and in larger perforations. These prognostic factors should be considered in surgical planning and patients should be advised to quit smoking. Tympanoplasty with cartilage graft had a hearing outcome comparable to temporalis fascia graft and should be considered in high-risk patients.
评估成人 I 型鼓室成形术的成功率，并探讨选择的预后因素对移植物吸收率的重要性。
回顾性分析 2013 年 1 月至 2017 年 12 月在我科行 I 型鼓室成形术的 155 例患者的病历。评估移植物吸收率，并分析性别、吸烟和耳部手术史、对侧耳状况、穿孔大小和位置、中耳黏膜状况、手术入路和移植物材料等预后因素对手术结果的影响。收集术前和术后的听力数据，并确定功能成功率。
总体手术解剖成功率为 75%。对所选变量的分析确定为解剖学不成功的独立预后因素（95%CI）：吸烟（OR=3.29，p<.01）、中耳鼓室硬化（OR=2.96；p=.04）。鼓膜面积 50%以上的穿孔对移植物吸收率有边缘影响（p=.05）。平均气导阈值平均改善 7.44dB，10dB 和 20dB 的 ABG 闭合率分别达到 47%和 84.5%。接受颞肌筋膜移植物的患者与接受软骨鼓室成形术的患者听力增益相似（7.7 与 7.3dB，p=.79）。
I 型鼓室成形术是治疗黏膜性 COM 的一种有效且安全的方法，具有较高的解剖成功率。在有吸烟习惯、中耳黏膜硬化和较大穿孔的患者中，结果较差。这些预后因素应在手术计划中考虑，并应建议患者戒烟。软骨移植物的鼓室成形术与颞肌筋膜移植物的听力结果相当，应在高危患者中考虑。
