Sugimoto Hisashi, Tamori Akiko, Hatano Miyako, Hasegawa Hiroki, Yoshizaki Tomokazu
Department of Otolaryngology-Head and Neck Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
J Otol. 2024 Apr;19(2):72-76. doi: 10.1016/j.joto.2024.04.004. Epub 2024 Oct 19.
Myringoplasty aims to improve hearing and prevent otorrhea, making graft uptake rates and hearing crucial considerations. This study analyzed the factors associated with unsuccessful graft uptake and hearing improvement to guide the selection of optimal surgical approaches for myringoplasty.
We retrospectively reviewed 56 ears with chronic otitis media. All patients were followed up for >6 months after tympanic membrane closure surgery. We compared the underlay method using the transcanal approach with the inlay method using the retroauricular approach for myringoplasty in patients with chronic otitis media. The underlay and inlay methods were used for 23 and 33 ears, respectively. The primary outcomes were graft uptake rate and hearing improvement. Additionally, factors such as the location of tympanic membrane perforation, patient age, and the degree of mastoid development were evaluated.
The perforation rate was high when the transcanal underlay method was employed to repair perforations in the anterior inferior quadrant. Both the underlay and inlay methods significantly improved hearing. However, the success rate of the inlay method was lower. Within the cases performed using the inlay method, outcomes tended to be poorer in older age groups. There were no significant differences in surgical success rates related to mastoid development.
The inlay method using the retroauricular approach is a favorable option for repairing perforations involving the anterior inferior quadrant. However, older patients presented lower rates of hearing improvement when the inlay method was used.
鼓膜成形术旨在改善听力并预防耳漏，因此移植物吸收率和听力是关键考量因素。本研究分析了与移植物吸收失败和听力改善相关的因素，以指导鼓膜成形术最佳手术方法的选择。
我们回顾性分析了56例慢性中耳炎患者的耳部情况。所有患者在鼓膜闭合手术后均接受了超过6个月的随访。我们比较了慢性中耳炎患者采用经耳道入路的夹层法与采用耳后入路的内植法进行鼓膜成形术的效果。夹层法和内植法分别应用于23耳和33耳。主要观察指标为移植物吸收率和听力改善情况。此外，还评估了鼓膜穿孔位置、患者年龄和乳突发育程度等因素。
采用经耳道夹层法修复前下象限穿孔时，穿孔率较高。夹层法和内植法均能显著改善听力。然而，内植法的成功率较低。在采用内植法的病例中，老年组的效果往往较差。与乳突发育相关的手术成功率无显著差异。
采用耳后入路的内植法是修复前下象限穿孔的理想选择。然而，老年患者采用内植法时听力改善率较低。
