Jackler R K, Schindler R A
Laryngoscope. 1984 Apr;94(4):495-500. doi: 10.1288/00005537-198404000-00013.
Otologists have long debated the importance of the mastoid in determining the success or failure of tympanic membrane reconstruction. The pneumatic spaces within the mastoid represent an "air reservoir" which can be drawn upon during periods of eustachian tube dysfunction and buffer the middle ear against the development of detrimental negative pressures. Mastoid inflammatory disease, if untreated, may result in recurrent suppuration and graft failure. Small mastoid volume, aside from its well known association with chronic infectious middle ear disease, has been shown to effect adversely graft survival following myringoplasty. In 48 patients undergoing myringoplasty with simple mastoidectomy, neither small mastoid size nor inflammatory mastoid disease significantly decreased the rate of graft healing. This suggests that simple mastoidectomy is an effective means of repneumatizing the mastoid and eradicating mastoid sources of infection. The successful surgical creation of a pneumatized mastoid cavity in communication with the middle ear was confirmed by postoperative computerized tomographic (CT) scans. In failed cases, CT scanning predictably identified residual mastoid disease. Simple mastoidectomy is considered to be a safe and useful adjunct to myringoplasty in selected cases of chronic otitis media with perforation.
长期以来，耳科医生一直在争论乳突在鼓膜重建成败中所起的作用。乳突内的含气腔隙是一个“空气储备库”，在咽鼓管功能障碍期间可被利用，缓冲中耳免受有害负压的影响。乳突炎性疾病若不治疗，可能导致反复化脓和移植物失败。除了与慢性感染性中耳疾病的已知关联外，乳突体积小已被证明会对鼓膜成形术后的移植物存活产生不利影响。在48例行鼓膜成形术并同时行单纯乳突切除术的患者中，乳突体积小和炎性乳突疾病均未显著降低移植物愈合率。这表明单纯乳突切除术是使乳突重新气化并根除乳突感染源的有效方法。术后计算机断层扫描（CT）证实了成功通过手术创建了与中耳相通的气化乳突腔。在失败的病例中，CT扫描可预测性地识别出残留的乳突疾病。在慢性中耳炎伴穿孔的特定病例中，单纯乳突切除术被认为是鼓膜成形术的一种安全且有用的辅助手段。
