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伴有和不伴有鼓膜硬化的穿孔性鼓膜中移植物摄取情况的比较:一项在三级医疗中心开展的前瞻性病例对照研究

Comparison of Graft Uptake in Perforated Eardrums with and without Myringosclerosis: A Prospective Case-control Study in a Tertiary Centre.

作者信息

Rehman Ayaz, Deva Faizah Ashfah Latief, Wani Asef Ahmad, Masoodi Majid, Malik Bashir, Makhdoomi Owais

机构信息

Department of Otorhinolaryngology, Head and Neck Surgery, SKIMS Medical College and Hospital, Srinagar, Jammu and Kashmir, India.

出版信息

Int Arch Otorhinolaryngol. 2025 Jan 31;29(1):1-9. doi: 10.1055/s-0044-1791730. eCollection 2025 Jan.

DOI:10.1055/s-0044-1791730
PMID:39897076
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11785424/
Abstract

Various factors have been reported to affect the rates of success after tympanoplasty, among them, myringosclerosis. However, there are few studies focusing only on the effect of myringosclerotic plaque removal on tympanoplasty outcomes.  To compare the outcome of tympanoplasty in perforated eardrums with and without myringosclerosis.  The study included patients aged between 21 and 53 years diagnosed at the outpatient department with inactive mucosal chronic otitis media. The sample was divided into the case group, which included subjects with tympanic membrane perforation and myringosclerosis, and the control group, which included subjects with tympanic membrane perforation only, without myringosclerosis. We assessed the audiological findings of the patients before and after surgery, as well as hearing gain, graft uptake, and residual perforation/reperforation.  No significant relationships were observed involving the age or sex of the patient and the closure rate or hearing gain, neither between the location of the perforation and graft uptake. Graft uptake was higher in patients with perforation size < 50%. The graft uptake and hearing gain were higher in the case group.  The removal of sclerotic plaques increases the surface of the raw area created by subepithelial excision of the myringosclerotic plaques, leading to a high rate of surgical success for the closure of tympanic membrane defects with coexisting myringosclerosis.

摘要

据报道,多种因素会影响鼓室成形术后的成功率,其中包括鼓膜硬化。然而,很少有研究仅关注鼓膜硬化斑块切除对鼓室成形术结果的影响。

为了比较有和没有鼓膜硬化的穿孔鼓膜鼓室成形术的结果。

该研究纳入了21至53岁在门诊被诊断为非活动性黏膜慢性中耳炎的患者。样本分为病例组,包括鼓膜穿孔并伴有鼓膜硬化的受试者,以及对照组,包括仅鼓膜穿孔而无鼓膜硬化的受试者。我们评估了患者手术前后的听力学检查结果,以及听力增益、移植物摄取情况和残余穿孔/再穿孔情况。

未观察到患者的年龄或性别与闭合率或听力增益之间存在显著关系,穿孔位置与移植物摄取之间也无显著关系。穿孔大小<50%的患者移植物摄取率更高。病例组的移植物摄取率和听力增益更高。

切除硬化斑块会增加因鼓膜硬化斑块上皮下切除而形成的创面面积,从而使伴有鼓膜硬化的鼓膜缺损闭合手术成功率较高。

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本文引用的文献

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Factors influencing successful reconstruction of tympanic membrane perforations: a systematic review and meta-analysis.影响鼓膜穿孔成功修复的因素:系统评价和荟萃分析。
Eur Arch Otorhinolaryngol. 2023 Jun;280(6):2639-2652. doi: 10.1007/s00405-023-07831-2. Epub 2023 Feb 22.
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Prognostic factors in type I tympanoplasty.I型鼓室成形术的预后因素
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Wound healing in adult skin: aiming for perfect regeneration.成人皮肤的伤口愈合:追求完美的再生。
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Evaluation of the organic and functional results of tympanoplasties through a retro-auricular approach at a medical residency unit.经耳后入路鼓室成形术的组织和功能效果评估。
Braz J Otorhinolaryngol. 2011 Mar-Apr;77(2):229-36. doi: 10.1590/s1808-86942011000200013.
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Influence of coexisting myringosclerosis on myringoplasty outcomes in children.并存鼓膜硬化症对儿童鼓膜成形术结果的影响。
J Laryngol Otol. 2009 Sep;123(9):969-72. doi: 10.1017/S0022215109005520. Epub 2009 May 20.
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Myringoplasty: impact of perforation size on closure and audiological improvement.鼓膜成形术:穿孔大小对愈合及听力改善的影响
J Laryngol Otol. 2009 Sep;123(9):973-7. doi: 10.1017/S0022215109004368. Epub 2009 Jan 12.
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Evaluation of prognostic factors and middle ear risk index in tympanoplasty.鼓室成形术中预后因素及中耳风险指数的评估
Otolaryngol Head Neck Surg. 2008 Sep;139(3):386-90. doi: 10.1016/j.otohns.2008.05.623.
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Frequency dependence of hearing loss with perforations.鼓膜穿孔所致听力损失的频率依赖性
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