Palva T
Department of Otolaryngology, University Central Hospital, Helsinki, Finland.
Acta Otolaryngol. 1988 Jan-Feb;105(1-2):82-9. doi: 10.3109/00016488809119449.
Revision surgery was performed in 185 ears which had earlier undergone a total of 276 tympanomastoid operations. An open cavity had been made in 98, obliteration in 44 and canal wall up surgery in 43 ears. All ears were now operated upon by the open method combined with ear canal reconstruction and mastoid obliteration. Mastoid cholesteatoma was found in 50% of the open cavities and in 63% of intact canal wall ears, while 80% of the obliterated ears showed mastoid retraction pockets with cholesteatoma. Semicircular canal fistulae occurred in all groups, most frequently in open cavities (11%). During the follow-up period after revision (average 5 years) 3% were reoperated upon because of a new cholesteatoma. In the whole series, average hearing levels were slightly better postoperatively and in 34% of the ears the A-B gap was 20 dB at most. The main reason for failure after primary surgery was inadequate mastoid and epitympanic bone work and failure to obliterate the medial parts of the cavity thoroughly.
对185只耳朵进行了翻修手术，这些耳朵此前总共接受了276次鼓室乳突手术。其中98只耳朵形成了开放腔，44只耳朵进行了填塞，43只耳朵进行了外耳道壁上手术。现在所有耳朵均采用开放方法联合外耳道重建和乳突填塞进行手术。在50%的开放腔耳朵和63%的完整外耳道壁耳朵中发现了乳突胆脂瘤，而80%的填塞耳朵显示有伴有胆脂瘤的乳突退缩袋。所有组均出现了半规管瘘，最常见于开放腔（11%）。在翻修后的随访期（平均5年），3%的患者因新出现的胆脂瘤而再次手术。在整个系列中，术后平均听力水平略有改善，34%的耳朵A-B间隙最多为20 dB。初次手术后失败的主要原因是乳突和上鼓室骨质处理不足，以及未能彻底填塞腔隙的内侧部分。
