Department of Otorhinolaryngology, Yiwu Central Hospital, 699, Jiangdong road, Yiwu, 322000, Zhejiang, China.
Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
Eur Arch Otorhinolaryngol. 2022 May;279(5):2293-2301. doi: 10.1007/s00405-021-06913-3. Epub 2021 May 30.
We compare the long-term efficacy of the cartilage-perichondrium modified over-underlay technique and transtympanic underlay alone technique using endoscopic myringoplasty without tympanomeatal flap elevating for repairing large chronic perforations.
Nine chronic large perforations with mucosal chronic otitis media were recruited and randomly allocated to endoscopic cartilage-perichondrium modified over-underlay myringoplasty (MOUM, n = 55) and endoscopic cartilage-perichondrium transtympanic underlay alone myringoplasty (TUAM, n = 54). The graft success rate, hearing gain, mean operation time and postoperative complications were compared between the groups at 6 and 24 months.
In total, 99 patients were finally analysed. The graft success rates 6 months after surgery between MOUM and TUAM groups were not significantly different (100.0% vs 96.0%, p = 0.484). However, the MOUM group had a significantly higher success rate 24 months after surgery than the TUAM group (93.9% vs 76.0%, p = 0.028). In addition, postoperative ABG < 10 dB was 73.5% patients in the MOUM group and 76.0% in the TUAM group, the difference wasn't significant (p = 0.953). CT examination revealed well-pneumatised middle ears 24 months after surgery in both groups, and no middle ear cholesteatoma was observed.
Endoscopic modified cartilage-perichondrium over-underlay myringoplasty without tympanomeatal flap elevating is reliable and effective for repairing large perforations. It improves the long-term graft success rate compared to the endoscopic cartilage-perichondrium transtympanic underlay alone technique. The risk for iatrogenic cholesteatoma is minimal.
我们比较了内镜鼓膜成形术不掀起鼓室瓣，采用软骨-软骨膜改良重叠覆盖技术与单纯经鼓室底覆盖技术治疗慢性大穿孔的长期疗效。
招募了 9 例伴有黏膜慢性中耳炎的慢性大穿孔患者，随机分为内镜下软骨-软骨膜改良重叠覆盖鼓膜成形术（MOUM）组（n=55）和内镜下软骨-软骨膜单纯经鼓室底覆盖鼓膜成形术（TUAM）组（n=54）。比较两组患者术后 6 个月和 24 个月时的移植物成功率、听力提高、平均手术时间和术后并发症。
共有 99 例患者最终纳入分析。术后 6 个月时，MOUM 组和 TUAM 组的移植物成功率无显著差异（100.0% vs 96.0%，p=0.484）。然而，MOUM 组术后 24 个月的成功率明显高于 TUAM 组（93.9% vs 76.0%，p=0.028）。此外，MOUM 组术后 ABG<10dB 的患者比例为 73.5%，TUAM 组为 76.0%，差异无统计学意义（p=0.953）。两组术后 24 个月 CT 检查均显示中耳充气良好，未见中耳胆脂瘤。
不掀起鼓室瓣的内镜下改良软骨-软骨膜重叠覆盖鼓膜成形术是治疗大穿孔的一种可靠有效的方法。与单纯经鼓室底覆盖软骨-软骨膜技术相比，它可提高长期移植物成功率。医源性胆脂瘤的风险极小。
