中耳填塞和纤维蛋白胶外耳填塞可提高不含透明质酸盘的脂肪鼓膜成形术的成功率。
Middle Ear Packing and External Ear Packing With Fibrin Glue Enhance the Success of Fat Myringoplasty Without Hyaluronic Acid Disc.
机构信息
Department of Otolaryngology, Chonnam National University Medical School, Gwangju, Republic of Korea.
Department of Otolaryngology, Cheomdan General Hospital, Gwangju, Republic of Korea.
出版信息
In Vivo. 2022 Jan-Feb;36(1):490-495. doi: 10.21873/invivo.12729.
BACKGROUND/AIM: Recently, hyaluronic acid disc has been known to enhance the success rate of fat myringoplasty. However, hyaluronic acid disc (Epidisc) is not covered by south Korean medical insurance. To date, fat myringoplasty using middle ear packing has rarely been reported. In this study, we studied whether middle ear packing with dexamethasone soaked gelfoam and fibrin glue over the fat graft could promote the success rate of tympanic membrane perforation (TMP) closure without hyaluronic acid disc, regardless of perforation size.
PATIENTS AND METHODS
Between January 2005 and July 2020, a total of 209 patients who underwent fat myringoplasty due to chronic TMP at a tertiary referral center were enrolled, and the success rate and audiologic outcomes were analyzed.
RESULTS
The mean successful tympanic membrane (TM) closure rate was 88.0%. The success rate by different age groups showed no significant difference. Further, the size of perforation showed no significant difference, and the perforation site (anterior or posterior) was not significant. The preoperative mean thresholds of air conduction (AC), bone conduction (BC), and air-bone gap (ABG) were 55.71, 12.98, and 42.73 dB respectively. The postoperative mean thresholds of AC, BC, and ABG were 23.67, 12.98, and 10.69 dB, respectively. Change in preoperative and postoperative hearing showed was statistically significant.
CONCLUSION
Middle ear packing by gelfoam combined with external ear canal packing using fibrin glue enabled stable adhesion between the remnant TM and the fat graft. Regardless of the size of the TMP, the success rate of the fat myringoplasty by our technique can be enhanced without use of hyaluronic acid disc.
背景/目的：最近，人们已经知道透明质酸盘可以提高脂肪鼓膜成形术的成功率。然而，透明质酸盘（Epidisc）不在韩国医疗保险范围内。迄今为止，使用中耳填塞物进行脂肪鼓膜成形术的报道很少。在这项研究中，我们研究了在没有透明质酸盘的情况下，使用浸有地塞米松的明胶海绵和纤维蛋白胶的中耳填塞物覆盖脂肪移植物是否可以提高鼓膜穿孔（TMP）闭合的成功率，而与穿孔大小无关。
患者和方法
在 2005 年 1 月至 2020 年 7 月期间，共有 209 名在三级转诊中心因慢性 TMP 而行脂肪鼓膜成形术的患者入组，分析了手术成功率和听力结果。
结果
平均鼓膜（TM）闭合成功率为 88.0%。不同年龄组的成功率无显著差异。进一步的，穿孔大小无显著差异，穿孔部位（前或后）也无显著差异。术前气导（AC）、骨导（BC）和气骨导差（ABG）的平均阈值分别为 55.71、12.98 和 42.73dB。术后 AC、BC 和 ABG 的平均阈值分别为 23.67、12.98 和 10.69dB，术前和术后听力变化有统计学意义。
结论
明胶海绵中耳填塞物结合纤维蛋白胶外耳道填塞物可以使残余 TM 与脂肪移植物之间稳定地黏附。无论 TMP 的大小如何，我们的技术都可以提高脂肪鼓膜成形术的成功率，而无需使用透明质酸盘。
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