Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00183, Rome, Italy.
Department of Otolaryngology, Kore University, Enna, Italy.
Eur Arch Otorhinolaryngol. 2024 Dec;281(12):6283-6291. doi: 10.1007/s00405-024-08845-0. Epub 2024 Aug 10.
Atelectasis otitis media (AtOM) is a chronic condition where the tympanic membrane (TM) becomes retracted towards the middle ear and the ossicular chain. Surgical treatment for this condition could be indicated based on stage of atelectasis, patient's clinical condition and hearing loss. Over the years, AtOM has been treated with various types of tympanoplasty under microscopic view. The aim of this study is to present the results of endoscopic ear surgery in AtOM.
Forty-five patients who underwent endoscopic trans-canal tympanoplasty were included in the study. Preoperative features, intraoperative findings and postoperative outcomes were collected.
Preoperatively, none of the study's patients were classified with a Sadè Grade I, whereas grades II, III and IV were 3 (6.6%), 23 (32.1%) and 19 (67.8%) respectively. The 3 patients with Sadè grade II showed a conductive hearing loss higher than 20 dB and a continuous ear fullness, therefore they were surgically treated. The postoperative graft success rate was estimated at 95.5%. During follow-up, 2 patients showed a TM perforation (at 6 and 12 months after surgery) whereas 1 patient experienced a recurrence of atelectasis in the TM (16 months after surgery). The overall success rate at the final follow-up was calculated at 88.8%. The average preoperative air-conduction threshold was 51.1 ± 21.5, which reduced to 34.6 ± 22.1 (p = 0.04) at follow-up. The preoperative air-bone gap decreased from 28 ± 7.2 to 11.8 ± 10 (p = 0.002) after surgery.
Atelectasis otitis media might be suitable for exclusive endoscopic surgical treatment, as it appears to exhibit a low recurrence rate and promising audiological outcomes.
中耳鼓室萎陷（AtOM）是一种慢性疾病，其鼓膜（TM）向中耳和听小骨链方向回缩。根据鼓室萎陷的阶段、患者的临床状况和听力损失，可能需要对此类病症进行手术治疗。多年来，AtOM 一直通过显微镜下的各种类型的鼓室成形术进行治疗。本研究旨在介绍内镜耳部手术在 AtOM 中的治疗效果。
本研究纳入了 45 名接受内镜经耳道鼓室成形术的患者。收集了患者的术前特征、术中发现和术后结果。
术前，本研究患者均未被分类为 Sade Ⅰ级，而 Sade Ⅱ级、Ⅲ级和Ⅳ级分别有 3（6.6%）例、23（32.1%）例和 19（67.8%）例。3 例 Sade Ⅱ级患者表现出听力损失超过 20dB 的传导性听力损失和持续性耳闷，因此对其进行了手术治疗。术后移植物成功率估计为 95.5%。随访期间，2 例患者出现鼓膜穿孔（术后 6 个月和 12 个月），1 例患者出现鼓膜再次萎陷（术后 16 个月）。最终随访时的总体成功率计算为 88.8%。术前平均气导阈值为 51.1±21.5dB，随访时降至 34.6±22.1dB（p=0.04）。术前气骨导差从 28±7.2dB 降至术后 11.8±10dB（p=0.002）。
中耳鼓室萎陷可能适合采用单纯的内镜手术治疗，因为它似乎具有较低的复发率和有前景的听力结果。
