Li Shan, Ke Jia, Yang Ruizhe, Zhang Ke, Pan Tao, Xin Ying, Ma Furong
Department of Otorhinolaryngology Head and Neck Surgery，the Third Hospital of Peking University，Beijing，100191，China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Apr;35(4):297-301. doi: 10.13201/j.issn.2096-7993.2021.04.003.
To assess and compare therapeutic effects and quality of life after endoscopic and microscopic myringoplasty using Chinese version of the Zurich chronic middle ear inventory（ZCMEI）. Patients with chronic suppurative otitis media underwent myringoplasty at the Third Hospital of Peking University from October 2018 to September 2019 were included in this study and divided into two groups: endoscopic tympanoplasty group（=40） and microscopic tympanoplasty group（=57）. ZCMEI survey and pure tone audiometry were conducted preoperatively and 3-9 months postoperatively. The operation time, intraoperative blood loss, length of hospital, graft success rate, complication rate, hearing improvement and quality of life improvement were compared. ①The operation time, length of hospital and intraoperative blood loss of endoscopic group were significantly lower（<0.05）. ②The graft success rate was 92.5% and 98.2%, respectively（>0.05）. The difference between the complication rate in two groups was not significant, but patients in endoscopic group had no symptoms of wound numbness or pain. ③Air conduction threshold（AC） and air-bone gap（ABG） were significantly lower after surgery in endoscopic group（=33） and microscopic group（=43）. The analyzed result of generalized linear model indicated surgical approach had no influence on postoperative AC and ABG（>0.05）. ④The total scores of ZCMEI were significantly improved in endoscopic group（=32） and microscopic group（=48） postoperatively, as well as the scores of ear symptoms, hearing and psychosocial impact（<0.05）. Preoperative and postoperative scores of medical resources were not significantly different in either groups（>0.05）. Controlling the course of disease, the total ZCMEI results and scores of each subscale in patients with single ear involved（=71） had no significant difference between two groups. Endoscopic myringoplasty has the advantages of minimal invasiveness, short operation time, and quick recovery evaluated from subjective and objective aspects. Audiometry improvement, graft success rate, complication rate and quality of life improvements are comparable between endoscopic tympanoplasty and conventional microscopic tympanoplasty. The assessment of the quality of life is of great significance in efficacy evaluation of otitis media. Doctors should comprehensively consider patient's subjective experience and the objective improvement to obtain the best clinical efficacy.
使用中文版苏黎世慢性中耳量表（ZCMEI）评估和比较内镜下与显微镜下鼓膜成形术后的治疗效果及生活质量。纳入2018年10月至2019年9月在北京大学第三医院接受鼓膜成形术的慢性化脓性中耳炎患者，分为两组：内镜下鼓室成形术组（=40）和显微镜下鼓室成形术组（=57）。术前及术后3 - 9个月进行ZCMEI调查和纯音听力测试。比较手术时间、术中出血量、住院时间、移植物成功率、并发症发生率、听力改善情况及生活质量改善情况。①内镜组的手术时间、住院时间及术中出血量显著更低（<0.05）。②移植物成功率分别为92.5%和98.2%（>0.05）。两组并发症发生率差异无统计学意义，但内镜组患者无伤口麻木或疼痛症状。③内镜组（=33）和显微镜组（=43）术后气导阈值（AC）和气骨导间距（ABG）均显著降低。广义线性模型分析结果表明手术方式对术后AC和ABG无影响（>0.05）。④内镜组（=32）和显微镜组（=48）术后ZCMEI总分显著改善，耳部症状、听力及心理社会影响评分亦显著改善（<0.05）。两组术前及术后医疗资源评分差异均无统计学意义（>0.05）。控制病程后，单耳受累患者（=71）的ZCMEI总分及各子量表评分在两组间无显著差异。从主观和客观方面评估，内镜下鼓膜成形术具有微创、手术时间短、恢复快的优点。内镜下鼓室成形术与传统显微镜下鼓室成形术在听力改善、移植物成功率、并发症发生率及生活质量改善方面相当。生活质量评估在中耳炎疗效评价中具有重要意义。医生应综合考虑患者的主观体验和客观改善情况以获得最佳临床疗效。
