Wang Jianyan, Chang Gaihua, Zhang Quanzhao, Chen Yubin
Department of Otorhinolaryngology Head and Neck Surgery，the Third Affiliated Hospital of Sun Yat-Sen University，Guangzhou，510630，China.
Department of Otorhinolaryngology Head and Neck Surgery，Macao Kiang Wu Hospital.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2025 Jan;39(1):77-83. doi: 10.13201/j.issn.2096-7993.2025.01.016.
To investigate the occurrence and managements of poor recovery after total endoscopic middle ear surgery. A total of 302 cases（315 ears） who underwent endoscopic middle ear surgery in our hospital from June 2020 to June 2021 were collected. Follow up by means of endoscopy, pure tone hearing threshold, tympanogram was conducted at 1 month, 3 months, 6 months and 1 year after surgery to analyze the incidence, possible causes, treatment strategies and effects of poor results tympanic membrane healing and hearing recovery. Among 302 patients（315 ears） followed up, there were 28 cases with poor recovery. There were fourteen cases of poor eardrum healing, of which 10 cases achieved healing of eardrum after tympanic membrane patching in the outpatient department, with a success rate of about 71.4%. TM recurrence adhesion occurred in 4 cases after surgeries of cholesteatoma and adhesive otitis media. One case completely recovered after self eustachian tube insufflation, while 2 cases maintained the degree of eardrum subsidence, and one ineffective patient chose resurgical treatment, with an effective rate was 75.0%. Failure in hearing improvement occurred in 8 cases, all of which underwent second surgical exploration, and seven cases were improved after the second surgery, with an effective rate of 87.5%. Among the 8 patients with no improvement or aggravation of hearing loss after surgery, four cases had postoperative B-type or C-type of tympanogram, and the hearing could not improve after self eustachian tube insufflation for secondary surgical exploration. and the hearing improved after the secondary surgery. Incorrect orientation of ossicular prosthesis was accounted for another 2 cases, the hearing was improved after the ossicular orientation adjustment. One patient with lateral healing of TM and failed hearing recovery was corrected by a second operation. One case of tympanosclerosis underwent stapes release surgery, but hearing recovery still failed. One patient had recurrent postoperative cicatricial atresia of external auditory canal, and the patient was reluctant to undergo reoperation. Postoperative delayed facial paralysis occurred in 1 case, and the facial paralysis recovered recovered after conservative treatments. Eardrum patch and eustachian tube autoflation are simple and effective early outpatient treatment for patient with poor recovery. For those who failed with conservative treatments such as eardrum patch or eustachian tube and poor hearing recovery, the second surgical exploration is safe and effective. Regular follow up after endoscopic middle ear surgery is necessary for the managements of poor recovery.
探讨全内镜中耳手术后恢复不佳的发生情况及处理方法。收集2020年6月至2021年6月在我院接受内镜中耳手术的302例患者（315耳）。术后1个月、3个月、6个月及1年通过内镜、纯音听力阈值、鼓室图进行随访，分析鼓膜愈合及听力恢复不佳的发生率、可能原因、治疗策略及效果。在302例接受随访的患者（315耳）中，有28例恢复不佳。鼓膜愈合不佳的有14例，其中10例在门诊行鼓膜修补术后鼓膜愈合，成功率约为71.4%。胆脂瘤型中耳炎及粘连性中耳炎手术后有4例出现鼓膜复发性粘连。1例经自行咽鼓管吹张后完全恢复，2例维持鼓膜内陷程度，1例无效患者选择再次手术治疗，有效率为75.0%。听力改善失败的有8例，均接受了二次手术探查，7例二次手术后听力改善，有效率为87.5%。在8例术后听力无改善或加重的患者中，4例术后鼓室图为B型或C型，经自行咽鼓管吹张后听力无改善而行二次手术探查，二次手术后听力改善。另外2例为听骨假体定位错误，听骨定位调整后听力改善。1例鼓膜外侧愈合且听力恢复失败的患者经二次手术纠正。1例鼓室硬化症患者行镫骨松解手术，但听力仍未恢复。1例患者术后外耳道复发性瘢痕闭锁，患者不愿再次手术。术后出现1例迟发性面瘫，经保守治疗后面瘫恢复。鼓膜修补及咽鼓管自行吹张是恢复不佳患者早期简单有效的门诊治疗方法。对于鼓膜修补或咽鼓管等保守治疗失败且听力恢复不佳的患者，二次手术探查安全有效。内镜中耳手术后定期随访对于恢复不佳的处理很有必要。
