The Twelfth People's Hospital Guangzhou, Guangzhou, China; The Twelfth People's Hospital Affiliated to Guangzhou Medical University, Guangzhou, China.
J Int Adv Otol. 2023 Mar;19(2):105-111. doi: 10.5152/iao.2023.22758.
In the surgical development of cholesteatoma, in order to reduce the recurrence of cholesteatoma, 2 kinds of surgeries were carried out: removal of Cog and Korner's septum to ventilate supratubal recess (supratubal recess opened) and obliteration of the mastoid and attic space (bony obliteration tympanoplasty) were invented, respectively. Their purpose is the same but the theoretical basis is different, and the comparison of these 2 methods is not reported in the current literature. This study aims to evaluate the rates of recurrent and residual cholesteatoma with the simple canal wall up and canal wall up-supratubal recess opened and canal wall up-bony obliteration tympanoplasty mastoidectomy in a large cohort of patients. The secondary objectives were to assess the 3 techniques' infection rates and hearing outcomes.
Overall, 352 patients with middle ear cholesteatoma preoperatively underwent temporal bone ultrahigh-resolution computed tomography scan. The shape of the Eustachian tube and the supratubal recess were analyzed, and superior and posterior tympanic recesses, including the supratubal recess, were opened in different surgical groups.
After 5 years of follow-up, the results show that the lowest recurrence rate was 6.6% (7/106) for canal wall up-supratubal recess opened, 10.9% (12/101) for canal wall up-bony obliteration tympanoplasty, and canal wall up had the highest recurrence rate of 19.31% (28/145). The postoperative infection rate was 5.7% in the canal wall up-supratubal recess opened group, 10.89% in the canal wall up-bony obliteration tympanoplasty group, and 7.59% in the simple canal wall up group. The postoperative median air conduction was increased 8 dB in the canal wall up-supratubal recess opened group, 1 dB in the canal wall up-bony obliteration tympanoplasty, and 6 dB in the simple canal wall up group.
Opening the supratubal recess to ensure the patency of the attic facilitates the gas exchange between the mastoid process and the middle ear and reduces the possibility of cholesteatoma recurrence.
在胆脂瘤的外科发展中，为了降低胆脂瘤的复发率，分别发明了两种手术：切除 Cog 和 Korner 隔以通风鼓窦上隐窝（鼓窦上隐窝开放）和阻塞乳突和鼓室上隐窝（骨性鼓室成形术）。它们的目的是相同的，但理论基础不同，目前文献中没有报道这两种方法的比较。本研究旨在评估单纯鼓室上壁切开术与鼓室上壁切开术联合鼓窦上隐窝开放术和鼓室上壁切开术联合骨性鼓室成形术在大样本患者中的复发性和残留胆脂瘤的发生率。次要目标是评估这 3 种技术的感染率和听力结果。
总体而言，352 例术前中耳胆脂瘤患者行颞骨超高分辨率 CT 扫描。分析咽鼓管和鼓窦上隐窝的形态，不同手术组开放鼓窦上隐窝和包括鼓窦上隐窝在内的上后鼓室隐窝。
5 年随访结果显示，鼓室上壁切开联合鼓窦上隐窝开放组复发率最低，为 6.6%（7/106）；鼓室上壁切开联合骨性鼓室成形术组复发率为 10.9%（12/101）；单纯鼓室上壁切开组复发率最高，为 19.31%（28/145）。鼓室上壁切开联合鼓窦上隐窝开放组术后感染率为 5.7%，鼓室上壁切开联合骨性鼓室成形术组为 10.89%，单纯鼓室上壁切开组为 7.59%。鼓室上壁切开联合鼓窦上隐窝开放组术后气导中位数增加 8dB，鼓室上壁切开联合骨性鼓室成形术组增加 1dB，单纯鼓室上壁切开组增加 6dB。
开放鼓窦上隐窝以保证鼓室上隐窝通畅，有利于乳突腔与中耳之间的气体交换，降低胆脂瘤复发的可能性。
