Naina P, Pokharel Apar, Syed Kamran Asif, John Mary, Varghese Ajoy Mathew, Kurien Mary
Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India.
Department of ENT, Pondicherry Institute of Medical Sciences, Puduchery, India.
Int Arch Otorhinolaryngol. 2020 Oct;24(4):e438-e443. doi: 10.1055/s-0039-3402432. Epub 2020 Feb 27.
The surgical outcome of chronic otitis media (COM) of the mucosal type in the pediatric population with high rates of recurrent tympanic membrane perforation is indeed a concern for the attending surgeon. The present study was done to evaluate the outcome of tympanoplasty in children with chronic otitis media mucosal type. A retrospective analysis of the medical records of all children, aged < 16 years old, who underwent tympanoplasty for COM of the mucosal type was performed. These patients were addressed by a three-point assessment, for predicting outcome of tympanoplasty, which included the age of the patient, addressing the nasal/pharyngeal issues, and the status of the COM (discharging or dry). Surgical success was assessed in terms of graft uptake and improvement of hearing. Factors affecting the surgical outcome were also analyzed. A total of 90 children underwent type 1 tympanoplasty; 7 were lost to follow-up and 10 had incomplete audiometric results. In the 73 tympanoplasties analyzed, graft uptake was seen in 91.7% of the patients. Children with longer duration of ear discharge (> 8 years) had greater hearing loss. Children aged > 8 years old showed statistically significant higher chance of graft uptake ( = 0.021). Five of the six children who had graft rejection had bilateral disease. A three-point assessment in the management of pediatric COM of the mucosal type offers good outcomes with post-tympanoplasty graft uptake rates > 90%.
对于小儿复发性鼓膜穿孔率较高的黏膜型慢性中耳炎（COM），其手术效果确实是主刀医生所关注的问题。本研究旨在评估黏膜型慢性中耳炎患儿鼓室成形术的效果。对所有年龄小于16岁、因黏膜型慢性中耳炎接受鼓室成形术的患儿的病历进行回顾性分析。通过三点评估来预测鼓室成形术的效果，这三点包括患儿年龄、处理鼻/咽问题以及慢性中耳炎的状态（有分泌物或干燥）。根据移植物的接受情况和听力改善情况评估手术成功率。还分析了影响手术效果的因素。共有90例患儿接受了I型鼓室成形术；7例失访，10例听力测试结果不完整。在分析的73例鼓室成形术中，91.7%的患儿移植物被接受。耳漏持续时间较长（>8年）的患儿听力损失更大。年龄大于8岁的患儿移植物被接受的几率在统计学上显著更高（P = 0.021）。6例移植物排斥患儿中有5例为双侧病变。对于黏膜型小儿慢性中耳炎的治疗，三点评估法能取得良好效果，鼓室成形术后移植物接受率>90%。
